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Randomized controlled trial of abdominal binders for postoperative pain, distress, and blood loss after cesarean delivery
International Journal of Gynecology & Obstetrics
Abstract
Objective:
To assess the effect of using abdominal binders on pain, distress, and postpartum hemorrhage after cesarean delivery.
Methods:
The present prospective randomized controlled trial enrolled patients undergoing non-emergency cesarean deliveries in Gonbad-e Kavus, Golestan Province, Iran, between January 22 and October 23, 2015. Patients were randomized in a 1:1 ratio by blocks of four or six to a control group or to use an abdominal binder after delivery; all patients received routine care. The primary outcomes were visual analog scale-assessed pain, symptom distress scale (SDS)-assessed distress, and hemoglobin and hematocrit levels. Participants and researchers were masked to treatment assignments until after cesarean delivery, and data analysis was unmasked; intention-to-treat analyses were performed.
Results:
There were 89 patients enrolled in each group, with no differences in baseline pain scores, SDS scores, and hemoglobin and hematocrit levels between the groups (all P>0.05). Pain and SDS scores were lower in the binder group at all post-baseline time points compared with the control group (all P<0.001). Hemoglobin and hematocrit levels were higher among patients who received binders 36 hours after baseline (both P<0.001). There was one patient who experienced hemorrhage in the binders group and one patient requested removal of their binder.
Conclusions:
Patients who received abdominal binders reported less pain, lower SDS scores, and higher hemoglobin and hematocrit levels following cesarean delivery. This article is protected by copyright. All rights reserved.
... Therefore, an abdominal binder is commonly and routinely used after abdominal surgery to prevent postoperative complications [4][5][6][7]. An abdominal binder covers the whole abdomen and it helps relieve pain, provides support for deep breathing exercise, and promotes walking ability [8,9]. Several studies have found that the use of an abdominal binder after abdominal surgery, including cesarean section and cardiac surgery, may be efficacious for reducing postoperative complications [4][5][6][7]. ...
... Moreover, the use of an abdominal binder after laparoscopic surgery may be unnecessary and uncomfortable for patients and can interrupt diet resumption. There have been reports that abdominal binder use after laparoscopic or open surgery both positively [4][5][6][7][8][9] and negatively [10][11][12] affects postoperative respiratory function, walking performance, and pain but no study has evaluated binder use solely for laparoscopic cholecystectomy surgery. Therefore, we performed a randomized controlled trial to evaluate the effect of abdominal binders after laparoscopic cholecystectomy by comparing postoperative outcomes in two patient groups especially to identify the difference of visual analogue scale (VAS) score (0-10) between the abdominal binder group and control group after laparoscopic cholecystectomy. ...
... Patients were requested to complete a questionnaire prior to discharge about their pain, degree of comfort, time to ambulation by own power, walking ability, return of bowel function, and lapse of time before full diet resumption. Patients were asked to rate their pain score using the VAS 12, 24, and 48 hours after surgery [8,9]. Degree of comfort and walking ability were subjectively reported by the patients. ...
Purpose:
The purpose of this randomized controlled trial was to compare the effects of abdominal binder after laparoscopic cholecystectomy.
Methods:
From August to December 2020, 66 patients who were set to undergo cholecystectomy were selected for a prospective trial at Kangbuk Samsung Hospital, Seoul, Republic of Korea, and their clinical characteristics and postoperative surgical outcomes were evaluated. Among 66 patients, 33 patients belong to the abdominal binder group and the other 33 patients belong to the control group.
Results:
The average hospital stay was 2.46 ± 1.29 days, and was not significantly different between the two groups. The average postoperative pain score (visual analogue scale, 0-10) 12, 24, and 48 hours after surgery were not significantly different. However, the degree of comfort score was significantly higher for the control group patients (2.56 vs. 3.33, p < 0.001). Time to the first ambulation, walking ability, return of bowel function, time to full diet resumption, and the numbers of analgesics and antiemetics administered were not significantly different between the two groups.
Conclusion:
No postoperative recovery benefit and no reduction in hospital stay was found in patients who used an abdominal binder while undergoing laparoscopic cholecystectomy. Statistically, between the group that used the binder and the one that did not, no significant differences in surgical outcome nor postoperative outcome were observed. The only exception was that the degree of comfort score was significantly higher in the control group. Therefore, in terms of patient benefit and convenience, wearing an abdominal binder after laparoscopic cholecystectomy is not recommended.
... These compression belts act by minimizing stress on the wound, reducing abdominal muscle activity during ambulation, improving overall mobility, and promoting deep breathing [17][18][19][20][21][22]. Compression may also prevent wound dehiscence and increase blood flow at the surgical site to promote healing and mitigate incision edema (seroma) [14,23,24]. Nevertheless, the evidence on the real effectiveness of abdominal binders is still lacking and their role in postpartum care remains unclear, as the majority of data derives from heterogeneous, small-scale studies. ...
... Fig. 1 shows the flow diagram (PRISMA template) of information derived from review of potentially relevant articles. Four RCTs including 601 women with an uncomplicated, singleton pregnancy randomized or not to abdominal binder after CD were included in the meta-analysis [23,[31][32][33]. ...
... All included studies [23,[31][32][33] assessed pain 24 h and 48 h after CD through the VAS score. There was no significant difference in postoperative pain among women who were randomized to abdominal binder either at 24 h (MD À0.97, 95 % CI À2.23 to 0.30; p = 0.13) or at 48 h (MD À0.30, 95 % CI À0.71 to 0.12; p = 0.15) after CD. ...
Objective
To evaluate the efficacy of abdominal binders in reducing postoperative pain, patient distress and surgical postoperative sequelae after cesarean delivery (CD).
Methods
A comprehensive search in electronic databases (MEDLINE, EMBASE, and Cochrane Central) was performed up to February 2021. Selection criteria included randomized clinical trials investigating the application or not of abdominal binder after CD. The primary outcome was postoperative pain, measured using the visual analog scale (VAS) pain score. Secondary outcomes were divided into short- and long-term postoperative outcomes, including patient distress, need for additional pain medications, time to mobilization, return to normal daily activities, surgical site infection, fascial dehiscence or incisional hernia, and rectus abdominis diastasis. The summary measures were reported as mean difference with 95 % confidence intervals (CI) using the random effects model of DerSimonian and Laird. An I² (Higgins I²) value of greater than 0% was used to identify heterogeneity.
Results
Four RCTs involving 601 women were included for meta-analysis: 310 (51.6 %) were randomized to the abdominal binder and 291 (48.4 %) to no abdominal binder group. There was no statistically significant difference between the two groups for VAS score either at 24 h (MD −0.97, 95 % CI −2.23 to 0.30; p = 0.13) and at 48 h (MD −0.30, 95 % CI −0.71 to 0.11; p = 0.15). Conversely, there was a significant reduction in postoperative distress (SDS) both at 24 h (MD −2.23, 95 % CI −3.77 to −0.70; p = 0.004) and 48 h (MD −2.37, 95 % CI −3.86 to −0.87; p = 0.002).
Conclusion
The present meta-analysis shows that the use of abdominal binders after CD significantly reduces patient distress.
... 17 Based on the literature search, few studies have addressed the role of abdominal binders in women undergoing a cesarean delivery with no consensus regarding their benefits. 14,18,19 While Ghana et al. 18 found the abdominal binder to be an effective option for pain relief after cesarean delivery, Gillier et al. 14 found no benefits for abdominal binders in improving pain and distress scores within 24-48 h after cesarean delivery. Additionally, Gustafson et al. 19 showed that the abdominal binder could be associated with improved postoperative pain but did not affect postoperative hemorrhage, and Karaca et al. 10 found a reduction in distress and improved mobilization after cesarean delivery with the use of an abdominal binder. ...
... 17 Based on the literature search, few studies have addressed the role of abdominal binders in women undergoing a cesarean delivery with no consensus regarding their benefits. 14,18,19 While Ghana et al. 18 found the abdominal binder to be an effective option for pain relief after cesarean delivery, Gillier et al. 14 found no benefits for abdominal binders in improving pain and distress scores within 24-48 h after cesarean delivery. Additionally, Gustafson et al. 19 showed that the abdominal binder could be associated with improved postoperative pain but did not affect postoperative hemorrhage, and Karaca et al. 10 found a reduction in distress and improved mobilization after cesarean delivery with the use of an abdominal binder. ...
... The references of included studies were searched manually, but no further records were added. Finally, six RCTs with 702 women 10,14,[18][19][20]27 were included ...
Background
Abdominal binder is a non‐pharmacological method of relieving pain after surgical procedures.
Objectives
To evaluate the effectiveness of the abdominal binder in relieving pain and distress scores after cesarean delivery (CD).
Search strategy
The following terms were searched: cesarean section, cesarean, caesarean, abdominal deliveries, C‐section, abdominal delivery, abdominal binding, binder, and abdominal binder.
Selection criteria
Randomized controlled trials (RCTs) with patients undergoing CD receiving an abdominal binder compared with non‐users of the abdominal binder.
Data collection and analysis
Five electronic databases were searched until November 2019. Records were screened for eligibility. Data were extracted independently and analyzed. The main outcomes were pain and distress scores.
Results
The final analysis included six RCTs. Overall effect estimate favored the abdominal binder group over the control group in the following outcomes: VAS pain scores after 24 h (mean difference [MD] −1.76; 95% confidence interval [CI] −3.14 to −0.39; P = 0.01), VAS scores after 48 h (MD −1.21; 95% CI −1.51 to −0.90; P < 0.001), distress score after 24 h (MD −1.87; 95% CI −3.01 to −0.73; P = 0.001), and distress score after 48 h (MD −1.87; 95% CI −3.07 to −0.67; P = 0.002).
Conclusion
The abdominal binder could be an effective, simple, non‐pharmacological option of relieving pain and distress after CD.
... The 17 studies that were reviewed based on the eligibility criteria varied in design (Table S2). Ten studies were randomized controlled trials [21,25,[40][41][42][43][44][45][46][47], one was a randomized crossover trial [48], two studies were randomized pilot studies [49,50], two were quasi-experimental studies [20,51], and there was one of each of the following designs-a prospective cohort study [24] and a case control study [52]. The studies were also diverse in geographical locations, which included (Table S2): New Zealand (n = 2) [21,50], United States of America (n = 2) [47,49], Iran (n = 2) [44,46], Germany (n = 3) [40,42,48], The Netherlands (n = 2) [20,52], Australia (n = 1) [25], Belgium (n = 1) [41], England (n = 1) [43], Scotland (n = 1) [51], Turkey (n = 1) [24], and Sweden (n = 1) [45]. ...
... Ten studies were randomized controlled trials [21,25,[40][41][42][43][44][45][46][47], one was a randomized crossover trial [48], two studies were randomized pilot studies [49,50], two were quasi-experimental studies [20,51], and there was one of each of the following designs-a prospective cohort study [24] and a case control study [52]. The studies were also diverse in geographical locations, which included (Table S2): New Zealand (n = 2) [21,50], United States of America (n = 2) [47,49], Iran (n = 2) [44,46], Germany (n = 3) [40,42,48], The Netherlands (n = 2) [20,52], Australia (n = 1) [25], Belgium (n = 1) [41], England (n = 1) [43], Scotland (n = 1) [51], Turkey (n = 1) [24], and Sweden (n = 1) [45]. [51], and Carr (2003) [49], who did not report participant ages. ...
... Two studies focused on women during pregnancy until gestational week 36-38 and performed follow up evaluations in the postpartum period [43,45]. Three of the studies occurred strictly in the immediate postnatal phase following delivery [46,47,51], while one study [20] investigated women within 5 years postpartum. The included studies exhibited considerable heterogeneity in participant characteristics, gestational weeks, weeks postpartum, sample sizes, duration and frequency of interventions, and functional outcome measures, and thus a meta-analysis was not conducted. ...
Conservative interventions for addressing prenatal and postnatal ailments have been described in the research literature. Research results indicated that maternity support belts assist with reducing pain and other symptoms in these phases; however, compliance in wearing maternity support belts is poor. To combat poor compliance, commercial manufacturers designed dynamic elastomeric fabric orthoses (DEFO)/compression garments that target prenatal and postnatal ailments. This systematic review aimed to identify, critically appraise, and synthesize key findings on the effectiveness, the feasibility, and the acceptability of using DEFO to manage ailments during pre-natal and postnatal phases of care. Electronic databases were systematically searched to identify relevant studies, resulting in 17 studies that met the eligibility criteria. There were variations in DEFO descriptors, including hosiery, support belts, abdominal binders and more, making it difficult to compare findings from the research articles regarding value of DEFO during prenatal and/or postnatal phases. A meta-synthesis of empirical research findings suggests wearing DEFOs during pregnancy has a significant desirable effect for managing pain and improving functional capacity. Further research is required to investigate the use of DEFOs for managing pain in the postnatal period and improving quality life during prenatal and postnatal care.
... Gillier et al. 14 found no significant difference in pain between their two study groups on postoperative day one, although a slight, non-significant difference was noted postoperative day two. In contrast, Ghana et al. 15 found patients receiving abdominal binders reported less postoperative pain and less blood loss. Our randomized controlled trial aimed to evaluate the effect of abdominal binder use on postoperative pain and hemorrhage among patients undergoing cesarean delivery. ...
... There is also no significant difference in the number of pads used between the two groups. 15 Karlstrom et al. 9 reported that 78% of women in their study experienced pain greater than or equal to 4 on the Visual Analog Scale (VAS) during the first 24 hours after cesarean. Since pain may interfere with recovery and impede maternal-infant interactions, results suggested that an abdominal binder may alleviate patient pain during the first 24 hours following surgery. ...
... This was not surprising, since most blood loss in a cesarean is intraoperatively. Ghana et al. 15 found a statistically significant higher blood loss volume in their control group between baseline and 36 hours. Similarly, based on results from our study, the difference in hemoglobin concentration levels before and 24 hours after surgery were lower among women in the binder group, although not statistically significant. ...
Background
A potential non-pharmacologic way to reduce postoperative pain and bleeding is using an abdominal binder during postoperative recovery. This study aims to determine the effect an elastic abdominal binder has on postoperative pain and hemorrhage after cesarean delivery.
Methods
A randomized, single-site, pilot trial was conducted at two prenatal care clinics and an academic hospital in Kansas. Beginning in April 2013, 60 patients were enrolled if delivering via cesarean. Participants were randomized to receive an abdominal binder or to a control group (did not use binder). Pain levels were reported by questionnaire one day after surgery using a 0 to 10 scale, with 10 being the worst pain. Patient characteristics and blood loss were assessed by medical record review.
Results
Of the 56 patients completing the study, 29 (51.8%) were randomized to the binder group and 27 (48.2%) were randomized to the control group. The binder group reported significantly lower pain score (p = 0.019) and average pain score (p = 0.024). There was no difference in body mass index, age, previous surgery, infant birth weight, estimated blood loss, and average dose of pain medication during the first 24 hours after the cesarean delivery between the two groups. There was no difference in pre- and post-operative hemoglobin levels by treatment group (p = 0.406).
Conclusions
Abdominal binders may be associated with improved postoperative pain scores but did not affect postoperative hemorrhage.
... There are few prospective randomized trials that have examined the possible effect of AB on the incidence of postoperative pain, wound complications, or incisional hernias. These trials have relatively small numbers of participants overall, and the procedures performed in the trials vary widely from general surgery to laparoscopic inguinal hernia repair to caesarean section [12][13][14][15][16][17][18]. In addition, none of the trials evaluated a possible preventive effect of wearing an AB on the incidence of postoperative incisional hernias after laparotomy as a primary endpoint. ...
... A total of 52 articles were identified between January and May 2024. After excluding irrelevant articles, sixteen articles were selected for further analysis [11][12][13][14][15][16][17][18][23][24][25][26][27][28][29][30]. These included a total of seven randomized controlled trials (RCTs), 6 no RCT and 3 meta-analyses (Figure 1 flow charts) ( Figure 2). ...
Background
The incidence of incisional hernia following laparotomy varies between 2% and 30%. It is well-established that the need to control several risk factors prior to surgery exists (weight loss before surgery, diabetes control). Postoperative abdominal binder (AB) is often recommended by surgeons, yet evidence on this topic is lacking. The aim of this review was to present current evidence on the use of abdominal binders after abdominal surgery.
Material and Methods
A comprehensive literature review between January and May 2024 was conducted using a range of search engines, including PubMed, Science Direct, EMBASE, Google Scholar, and Google. The following keywords were used: “abdominal binder,” “abdominal support,” “hernia,” “girdle and hernia,” “compression belt and hernia,” and “abdominal support and hernia.”
Results
Sixteen articles were selected for further analysis (7 RCTs, 6 non-RCTs and 3 meta-analyses). None of the studies reported a reduction in the incidence of abdominal dehiscence or incisional hernia. Postoperative use of the AB has been shown to reduce postoperative discomfort and pain for a limited period of up to 48–72 h. There was no discernible difference in the incidence of surgical site complications.
Conclusion
The current evidence indicates that the use of AB following abdominal surgery is safe, although no benefit has been established (except 48 h after surgery). AB may enhance comfort in select patients; however, further studies are necessary to justify their routine use, with a particular focus on the medical and economic implications.
... 6 The other benefits of abdominal binder are speeding the uterine and other organs involution, compressing the abdomen so that it helps tissue repair by increasing blood flow. 7 Based on the economic cost of abdominal binder and limited availability of injectable analgesic drug in rural hospital, this study aims to determine the effectivity of abdominal binder use after cesarean section related to pain and mobilization. It hopes that this study is able to apply in this rural hospital to improve the quality service of reproductive women's health. ...
... Several studies has shown that use of an elastic abdominal binder reduces postoperative pain and distress. 7,13,14 Postoperative pain also influenced breastfeeding and infant care. 15 Our study showed the decrease of pain in abdominal binder; the benefit of elastic abdominal binders after cesarean section in rural area volume 22, issue 3, July -september 2023 16 Several studies showed the mobilization postoperatively was longer in abdominal binder group than casual fashion through objective walking distance test. ...
Introduction: Cesarean section (CS) is the most common abdominal surgery procedure in the world. This study aims to determine the effectivity of abdominal binder use after cesarean section related to pain and mobilization. Methods: This was a randomized controlled, single-site, pilot trial study conducted in RSUD SoE, Timor Tengah Selatan, East Nusa Tenggara, Indonesia. Women with singleton term pregnancy undergoing cesarean section in our hospital were eligible to participate in the study. We excluded patients with history of cesarean section, second stage dystocia, abnormal placenta, hemoglobin level preoperative less than 10 g/dL, chorioamnionitis, cesarean hysterectomy due to severe hemorrhage, organ injury, and outside spinal anesthesia during cesarean section. Data were analyzed using IBM SPSS version 20. Results: There were 60 participants randomized into control and intervention (binder) group. There was no difference in age, height, weight, body mass index (BMI), gestational age, infant birth weight, and length between groups (p>0.027). The use of an elastic abdominal binder can speed up the rate of mobilization, shown by 2-minute walking test (p<0.05). Based on BPI-SF, the postoperative pain in elastic abdominal binder group had lower mean value than control group (p<0.05). Impact of pain to daily activities based on BPI-SF and SDS showed no difference between both groups (p>0.05). Conclusion: This study showed the benefit of abdominal binder after CS is to enhance the mobilization and reduce postoperative pain.
... However, none of these advantages were demonstrated in a similar study by Olsen et al. [8]. Likewise, data from randomized controlled trials on benefits of the binder use following cesarean delivery were conflicting [9][10][11][12]. In the only study that assessed the role of abdominal binder use after gynecologic surgery [13], the authors observed increased number of ambulatory events in the first 24 h associated with the binder use but only in those who had vertical incision and age ≥ 50. ...
... This could explain the inconsistency in the effect of the binder on pain among previous studies. (Table S1) For younger and healthier women who had less complex procedure such as cesarean section, the benefit of the binder use on pain was less noticeable and conflicting [9][10][11][12]. However, with more extensive and complicated procedures performed for gastrointestinal malignancies, the more consistent pain-relieving effect of the binder was observed [5,7]. ...
Background and Objectives: Clinicians have been using elastic abdominal binder for stabilizing incision site after major abdominal surgery. However, the benefits of that practice have never been formally assessed. The aim of this study was to examine the effects of the use of elastic abdominal binder on postoperative pain and recovery of gynecologic cancer patients. Materials and Methods: One-hundred and nine women diagnosed with cervical, endometrial, or ovarian cancer, who underwent open abdominal surgery were assigned randomly into two groups: intervention (56 patients) and control (53 patients). The women in the intervention group applied abdominal binder from postoperative day 1. For the control group, the women did not wear the binder or similar devices. The primary outcomes were pain and functional recovery. Subgroup analysis on participants age ≥ 50 was also performed. Results: For the entire study cohort, the baseline, postoperative day 1, and postoperative day 2 pain scores in the intervention group were significantly lower than the control group. However, there was no significant difference between the groups for postoperative day 3 pain score and for the change in pain scores from the baseline value. Of note, the age ≥ 50 subgroup represented a more balanced cohort with comparable baseline pain scores between the study groups. For this population, the pain scores for postoperative day 1–3 were significantly lower in the intervention group. The intervention group had a longer six-minute walking distance on postoperative day 3 with a trend toward a smaller difference in the day 3 distance from the baseline. Conclusions: The potential benefits of abdominal binder use in reducing postoperative pain and improving functional recovery after open gynecologic cancer surgery could be demonstrated only in those age ≥ 50.
... Three studies evaluated the use of elastic abdominal binders after caesarean section [132][133][134]. In all three, a clinically-relevant reduction in pain scores and rescue analgesia was noted [132][133][134]. ...
... Three studies evaluated the use of elastic abdominal binders after caesarean section [132][133][134]. In all three, a clinically-relevant reduction in pain scores and rescue analgesia was noted [132][133][134]. Two studies evaluated the application of manual cervical dilation at the end of caesarean section and compared it with no cervical dilation and came to conflicting conclusions [135,136]. ...
Caesarean section is associated with moderate-to-severe postoperative pain, which can influence postoperative recovery and patient satisfaction as well as breastfeeding success and mother-child bonding. The aim of this systematic review was to update the available literature and develop recommendations for optimal pain management after elective caesarean section under neuraxial anaesthesia. A systematic review utilising procedure-specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials published in the English language between 1 May 2014 and 22 October 2020 evaluating the effects of analgesic, anaesthetic and surgical interventions were retrieved from MEDLINE, Embase and Cochrane databases. Studies evaluating pain management for emergency or unplanned operative deliveries or caesarean section performed under general anaesthesia were excluded. A total of 145 studies met the inclusion criteria. For patients undergoing elective caesarean section performed under neuraxial anaesthesia, recommendations include intrathecal morphine 50-100 µg or diamorphine 300 µg administered pre-operatively; paracetamol; non-steroidal anti-inflammatory drugs; and intravenous dexamethasone administered after delivery. If intrathecal opioid was not administered, single-injection local anaesthetic wound infiltration; continuous wound local anaesthetic infusion; and/or fascial plane blocks such as transversus abdominis plane or quadratus lumborum blocks are recommended. The postoperative regimen should include regular paracetamol and non-steroidal anti-inflammatory drugs with opioids used for rescue. The surgical technique should include a Joel-Cohen incision; non-closure of the peritoneum; and abdominal binders. Transcutaneous electrical nerve stimulation could be used as analgesic adjunct. Some of the interventions, although effective, carry risks, and consequentially were omitted from the recommendations. Some interventions were not recommended due to insufficient, inconsistent or lack of evidence. Of note, these recommendations may not be applicable to unplanned deliveries or caesarean section performed under general anaesthesia.
... The binder is hypothesized to improve postoperative pulmonary function by limiting the movement of abdominal wall muscles [5]. In particular, it might speed up the return of the uterus and the other organs to their pre-pregnancy positions by compressing the abdomen, and it might help tissue repair by increasing blood flow [6]. The benefits of abdominal binder use for reducing pain and improving mobility after major abdominal surgeries are well-established in the literature [7,8]. ...
... A systematic review of the effects of postoperative binder usage on pain has also revealed that using abdominal binders reduces postoperative pain [11]. Similarly, Ghana et al. and Gustafson et al. showed that abdominal binder usage after CS reduces the feeling of pain and distress [6,12]. In contrast, another previous study has suggested that using an abdominal binder does not have an impact on VAS scores or SDS scores [4]. ...
Objective:
The purpose of the present study was to determine the effect of abdominal binder usage on mobilization, postoperative pain, and distress after cesarean delivery.
Materials and methods:
This prospective randomized controlled study was conducted between September 1, 2017 and January 31, 2018 at Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey. A total of 89 women undergoing elective cesarean were randomized to the study (binder, n=45) or control (no binder, n=44) groups. Patients in the study group were fitted with a binder before leaving the operating room. Mobilization (6-minute walk test), postoperative pain (measured by Short-Form McGill Pain Questionnaire and Visual Analog Scale), and perceived distress status of both groups were evaluated within 8th (first mobilization time), 24th, and 48th h of surgery.
Results:
We found that the binder group (BG) walked longer than the control group during the 6-minute walking distance test. At the first mobilization time (postoperative 8th h), the BG (99.4±27.3 m) covered significantly more distance than the control group (81.0±22.2 m) (p=0.001) in the walking distance test. At postoperative 24th h, the McGill pain score in the BG was significantly lower than that in the control group (p=0.004). For all three test times, the Symptom Distress Scale of the BG was lower than that of the control group (postoperative 8th h p=0.024, 24th h p<0.001, and 48th h p<0.001).
Conclusion:
The evidence is consistent with abdominal binder usage after cesarean section decreasing the feeling of distress and increasing mobility.
... Both elastic and non-elastic binders are available in the market. Abdominal binder helps to reduce postoperative pain, distress, and hemorrhage after cesarean section [4]. These are also used in patients with spinal cord injury to support the abdomen, to maintain intraabdominal pressure, improve respiratory function and improve overall mobility [5]. ...
... Our study population included women undergoing cesarean section. Many past studies investigating the role of abdominal binder in reducing postoperative pain after cesarean section reported lower pain scores [3,4]. Gillier et al., however, reported no significant difference amongst VAS pain score between the binder and non-binder group [17]. ...
Objective
To compare the effect of abdominal binder versus no binder after major abdominal surgery and cesarean section on various post-operative recovery parameters.
Materials and methods
This is a randomized controlled trial conducted at the Department of General Surgery and Obstetrics, Civil Hospital, Karachi, Pakistan. All those patients aged ≥18 years having abdominal surgery including elective and emergency abdominal surgery and cesarean sections with American Society of Anesthesiologists Class I-III were included in the study. Randomization was done using the sealed envelope method by the principal investigator. The intervention group wore an abdominal binder postoperatively while the control group did not use it. Mobilization and the pain status of both groups were evaluated on the first, fourth, and seventh days after surgery.
Results
Primary outcome variables were mobility, assessed via 6-minute walk test (6MWT) and postoperative pain, evaluated via visual analogue scale. There was no statistically significant difference in the 6MWT distance before (p = 0.278) and on postoperative day one of the surgery (p = 0.0762). However, the difference was significant on fourth (p < 0.001) and seventh day (p value < 0.001). With regards to the pain status, patients in the binder group reported significantly less postoperative pain on first, fourth, and seventh (p value < 0.001) day compared to the non-binder group.
Conclusion
The use of abdominal binder postoperatively significantly reduced pain and improved mobility in both obstetric and surgery patients.
... The pooled result of all the studies showed that the risk of vaginal bleeding was higher in the expectant group as this group needs to wait for the expulsion of the gestation tissue. The risk of abdominal pain was higher in the misoprostol group when compared to other intervention [43,44]. ...
An increase in miscarriage in the first trimester of gestation and its associated complication is burden-some on the quality of life of a woman. Medical, surgical, and expectant care are carried out after the miscarriage to remove any remaining tissues in the uterus. Understanding the efficacy and safety of these interventions will raise awareness and be a deciding factor to choose an appropriate treatment plan. Present review aims to determine the efficacy and safety of medical, surgical, and expectant care of various medical and surgical methods for first-trimester miscarriage. This review included studies that allocated women to medical, surgical or expectant management in the first trimester. PubMed, Cochrane Library, MEDLINE, and Embase Library were searched for the literature. The primary outcome was the complete evacuation of products of conception. Data were independently reviewed, graded for evidence quality, and assessed for risk bias by using the guidelines of PRISMA (Preferred Report Items for Systematic Review and Meta-Analysis). 21 eligible articles were included in this systematic review, comprising of 7931 patients undergoing medical, surgical or expectant-management for early spontaneous-miscarriage. The success rate in surgical intervention was higher when compared with medical intervention (OR: 16.12 [9.11, 28.52]) and expectant management (OR: 2.78 [2.13, 3.61]). Whereas medical intervention had a high success rate when compared with expectant-management (OR: 4.29 [2.31, 7.97]). The review determines the effect of medical, surgical, and expectant-management procedures on women who have had spontaneous-miscarriages in their first-trimester. PROSPERO-International prospective register of systematic reviews–CRD42020154395.
... They were prescribed an abdominal binder (CLING, Maternity Corset) on the 2 nd day of their delivery as per their girth measurement taken in crook lying with complete expiration. [9][10][11] A measurement was obtained by a measuring tape. A therapist measured the area where the maximum abdominal bulge was noted with measuring tape in centimeters. ...
Context
Constipation being one of the most common and exasperating postpartum problems in Female population, i.e., defined as a large bowel problem leading to pain while defecating, hard and lumpy stools resulting in strain, and a sense of incomplete evacuating. It impacts the quality of life of every individual.
Aim
To investigate the effect of abdominal binder on constipation in early puerperium period.
Setting and design
The department of OBG physiotherapy at KLE Hospital in Belagavi. Karnataka India did a pilot study.
Methods and Materials
17 women between 19 and 35 years of age within the early puerperium period having constipation. The women reporting any chronic history of constipation and laxatives induced after the delivery were not included in the study. They were administered with the Modified Constipation Assessment Scale (MCAS), which rated them into mild, moderate, and severe constipation, and the Visual Analog Scale (VAS), to rate the abdominal discomfort due to constipation. The binder was prescribed for 2 days. Both pre-.and post-intervention data were collected and were statistically analyzed to know the effect.
Statistical analysis used
Parametric Paired sample t-test was used to compare the results.
Results
According to Paired sample t-test, the difference between the values of pre- and post-treatment with a P <5% significance level (i.e. 0.002 < 0.05) on MCAS can be observed. Similarly, on VAS, the significant and reliable statistical differences on the pre-.and post-treatment values with P <5% significance level (i.e., 0.001 < 0.05) can be observed. Therefore, this study justifies the improvements in health outcome post-intervention.
Conclusion
The study concluded that the abdominal binder has an effect on constipation within the early puerperium period. The binder also helps to relieve the abdominal discomfort as a result of constipation.
... By promoting early recovery we can minimize the risk of development of deep venous thrombosis, hypostatic pneumonias and muscle atrophy 10 . Abdominal binders improve recovery process by different mechanisms; especially by reducing postoperative pain, distress, psychological stress; as was shown by Ghana et al 11 . in a study on patients who underwent caesarean section. Some studies also claim that binders can reduce the risk of abdominal dehiscence 12 . ...
Background: In order to augment the postoperative recovery process in patients undergoing laparotomy, various methods have been evaluated in the past. One such strategy is the use of postoperative abdominal binder. Objective: We compared the efficacy of abdominal binder use in patients undergoing emergency laparotomy by objective comparison of 6-minute walk test and pain on visual analogue scale. Place of study: Departments of Surgery in both Benazir Bhutto Hospital and District Head Quarter Hospital affiliated with Rawalpindi Medical University, Rawalpindi Material and Methods: It was a randomized controlled trial that was carried out at Departments of Surgery of Rawalpindi Medical University, from October 2021 till May 2022. It included 100 patients, 50 in binder group and 50 in non-binder group. The study included patients from 18 to 65 years of age undergoing emergency exploratory laparotomy for acute abdomen or abdominal trauma having ASA Class I-II. In the postoperative period mobility was assessed by 6-minute walk test (6MWT) and pain was assessed using the VAS. Data was analyzed using SPSS version 20. The mean 6 MWT distance and pain score (VAS) was compared between the binder and no-binder group using the independent samples t-test. Results were considered statistically significant if the p value was < 0.05. Results: The 6MWT distance and the pain scores of patients in the binder group did not differ significantly from the pain scores in the non-binder group on first, third, fifth and fourteenth postoperative day (p>0.05). Conclusion: We did not find a statistically significant difference between the patients using binder and the patients not using binder after surgery with respect to mobilization and pain in the postoperative period. Keywords: major abdominal surgery; exploratory laparotomy, abdominal binder; 6-minute walk test; visual analogue scale
... Fourteen randomized controlled trials involving 1,317 participants met the inclusion criteria. Five studies did not provide complete data and were synthesized for the qualitative synthesis [15,18,21,23,32]. Eight studies involving 821 patients were included in the meta-analysis of pain and were synthesized for the VAS scores assessed on postoperative day 1 [12,17,22,24,25,27,28,33]. Three of the eight studies also were included in the meta-analysis of the physical function evaluated by the 6MWT on postoperative day 1 [24,25,33]. ...
Objective
This study aimed to assess the effectiveness of abdominal binders (ABs) on postoperative pain and functional recovery in patients receiving abdominal surgery.
Methods
The Pubmed, Embase, Cochrane Library, and PEDro databases were searched for clinical trials published up to November 30, 2019. Randomized controlled trials that compared the effects of wearing an AB to not wearing an AB in participants after abdominal surgery were included. The primary outcomes were pain, pulmonary function, and physical function, as assessed by the visual analog scale (VAS) score, a spirometry device, and the 6-min walk test (6MWT), respectively. The registration number of this review in PROSPERO is CRD42020165303.
Results
Fourteen trials involving 1317 participants were included. Pooled estimates for the VAS score and the 6MWT showed significant differences between the AB group and the control group, especially on the fourth day following surgery (Mean Difference (MD) = -2.82, 95% Confidence Interval (CI) -3.41 to -2.22, P < 0.00001; MD = 50.97 m, 95% CI 39.99 to 61.95 m, P < 0.00001). However, no significant differences were found in pulmonary function (forced vital capacity (FVC): MD = 0.01, 95% CI -0.29 to -0.32, P = 0.94; forced expiratory volume during 1 s (FEV1): MD = -0.05; 95% CI -0.24 to 0.14; p = 0.63; FEV1/FVC: MD = 3.14, 95% CI -2.78 to 9.06, P = 0.30).
Conclusion
ABs probably improve postoperative pain and physical function, especially on the fourth day or more following abdominal surgery, but they have no effects on pulmonary function.
... Emotion was evaluated at the initial pregnancy test, at 1 week prior to the expected date of childbirth, and at 6 months postpartum, by using the Symptom Distress Scale (SDS) [25]. Sexual function was evaluated at 6 months postpartum, according to the Female Sexual Function Index (FSFI) [26]. ...
Background
During pregnancy, appropriate physical activity plays critical roles in maternal and fetal health. This study investigated the effects of Sophrology childbirth-Kegel-Lamaze respiratory training (SLK triple therapy) on maternal and newborn health, pelvic floor function, and quality of life.
Material/Methods
Single-pregnant primiparous women involved in this study were divided into the control group (n=120) and the SLK triple therapy group (n=120). SLK triple therapy was taught to and practiced by the women in the SLK triple therapy group. Data on delivery mode (natural delivery or cesarean section), postpartum complications (postpartum urinary incontinence, postpartum hemorrhage), and birth process were recorded. Apgar scores and body weight of newborns were evaluated. Pelvic floor function, postpartum emotion, and sexual functions were assessed.
Results
Women in the SLK triple therapy group had significantly better natural delivery rate compared to the control group (p<0.05). SLK triple therapy significantly decreased the postpartum urinary incontinence rate and reduced the postpartum hemorrhage rate compared to the control group (p<0.05). Birth process and postpartum hemorrhage volume in the SLK triple therapy group were also significantly lower compared to the control group (p<0.05). Apgar scores were significantly lower and body weights were significantly higher in the SLK triple therapy group compared to the control group (p<0.05). SLK triple therapy significantly improved pelvic floor function compared to the control group (p<0.05). SLK triple therapy significantly decreased SDS scores and enhanced FSFI scores compared to the control group (p<0.05).
Conclusions
SLK triple therapy improved maternal and fetal health by improving pregnancy outcomes, promoting postpartum pelvic floor function, reducing the incidence of depression, and enhancing sexual function. Therefore, SLK triple therapy has great utility in treating primiparous women.
Introduction
Abdominal binders consist of a wide compression belt that encircles the abdomen, theoretically supporting the abdominal wall. However, their use after ventral hernia repair is debated. Therefore, this meta-analysis evaluates their efficacy.
Methods
We searched PubMed, Embase, and Cochrane Central for randomized controlled trials (RCTs) comparing the effects of abdominal binders after ventral hernia repair. Outcomes included postoperative pain using the visual analog scale (VAS), surgical site infection (SSI), seroma formation and size, general well-being, activity limitation, forced expiratory volume in the first second (FEV1), and a 6-min walk test. Statistical analysis was performed with Review Manager 5.4.1 using a random-effects model.
Results
We included five RCTs encompassing 297 patients. Overall analysis showed decreased SSI rates (RR 0.21; 95% CI 0.07 to 0.59; p = 0.003; I² = 0%) and reduced pain two weeks after surgery (MD −0.89; 95% CI −1.41 to −0.37; p = 0.0008; I² = 0%) using abdominal binders. For patients undergoing open ventral hernia repair, it also demonstrated reduced SSI, pain four weeks after surgery (MD −0.60; 95% CI −0.88 to −0.32; p < 0.0001; I² = 66%) and increased 6-min walk test performance four weeks after the procedure (MD 32.78 m; 95% CI 15.28 to 50.29 m; p = 0.0002; I² = 0%).
Conclusion
Abdominal binders may decrease SSI, postoperative pain, and increase physical condition, particularly in open ventral hernia repair. Further studies are still required to evaluate the role of abdominal binders in minimally invasive techniques.
Background : This study investigates the physical activity and apparel choices of perinatal women. The perinatal period involves significant anatomical, physiological, and biomechanical changes as the body prepares to carry and deliver a child, and the recovery process which follows. Despite the recognized benefits of physical activity, returning to physical activity postpartum can be difficult. Methods : One hundred and six postpartum women completed an online questionnaire exploring women’s physical activity habits before, during, and after pregnancy, along with their use of activewear/compression garments during this time. Statistical analyses, including chi-squared tests, investigated the relationship between initiation of physical activity postpartum (by and after 12 weeks) and: delivery method (vaginal, c-section, and assisted), perineal trauma, activewear purchase, and prepregnancy activity level. Thematic analysis was applied to identify themes from participant’s answers. Results : A vaginal delivery correlated with a higher likelihood of resuming physical activity within 12 weeks postpartum. Moreover, a high level of activity prepregnancy was associated with a high level of physical activity postpartum. The study identified key reasons for the cessation of physical activity during pregnancy including discomfort, tiredness, and misinformation. Barriers hindering the return to physical activity postpartum included discomfort, misinformation, and time constraints. Few participants used compression garments in the postpartum period, with the majority leveraging them to alleviate pain (71%). Conclusions : This study highlights a crucial gap in utilization of compression garments during the postpartum period. Understanding these factors is pivotal in enhancing support for postpartum women in their pursuit of resuming physical activity.
Cesarean delivery may be complicated by pain, bleeding, excessive use of painkillers, infection, or
other issues. A potential non-pharmacological way to reduce post-operative pain is the use of an
abdominal binder, which may also affect the mobility of patients. The present investigation was
performed with the purpose of evaluating the effect of using an abdominal binder on pain intensity
and mobility after caesarean section at Isfahan University of Medical Sciences. This study was a
blind, two-group, one-stage parallel clinical trial with a control group. 184 pregnant women who
met the inclusion criteria were randomized into two intervention and control groups with a block
size of 4 and 6 and with an allocation ratio of 1:1. Each patient in the intervention group used an
abdominal binder before leaving the operating room. Both groups received routine care and
medication. Data collection was performed by using demographic information questionnaire, VAS
scale, and recording of painkillers received. Mobility was evaluated by performing a six-minute
walking test. Data analysis was done using SPSS version 24 software, independent T test and ANOVA
test. A value of P < 0.05 was considered significant. 184 women candidates for cesarean section
were divided in two groups of 92 people with the average age of the control group (27.7±7.3) and
the intervention group (28.58±7.01). The results demonstrated that the two investigated groups were
identical in terms of demographic characteristics. Based on the independent t-test, the pain
intensity score of the intervention group at different times (6, 12, 18 and 24 hours after the
operation) was significantly lower than the control group (P<0.05). In addition, 12 and 24 hours
after the operation, the mean and standard deviation of the mobility score of the control group was
significantly lower than the intervention group (P=0.038). The mean and standard deviation of the
number of times receiving sedative by the intervention group was significantly lower than the
control group (P<0.001). The use of abdominal binder after caesarean section was effective in
reducing pain, improving mobility, and receiving
sedatives in some periods of time.
An increase in miscarriage in the first trimester of gestation and its associated complication is burden-some on the quality of life of a woman. Medical, surgical, and expectant care are carried out after the miscarriage to remove any remaining tissues in the uterus. Understanding the efficacy and safety of these interventions will raise awareness and be a deciding factor to choose an appropriate treatment plan. Present review aims to determine the efficacy and safety of medical, surgical, and expectant care of various medical and surgical methods for first-trimester miscarriage. This review included studies that allocated women to medical, surgical or expectant management in the first trimester. PubMed, Cochrane Library, MEDLINE, and Embase Library were searched for the literature. The primary outcome was the complete evacuation of products of conception. Data were independently reviewed, graded for evidence quality, and assessed for risk bias by using the guidelines of PRISAM (Preferred Report Items for Systematic Review and Meta-Analysis). 21 eligible articles were included in this systematic review, comprising of 7931 patients undergoing medical, surgical or expectant-management for early spontaneous-miscarriage. The success rate in surgical intervention was higher when compared with medical intervention (OR: 16.12 [9.11, 28.52]) and expectant management (OR: 2.78 [2.13, 3.61]). Whereas medical intervention had a high success rate when compared with expectant-management (OR: 4.29 [2.31, 7.97]). The review determines the effect of medical, surgical, and expectant-management procedures on women who have had spontaneous-miscarriages in their first-trimester. PROSPERO-International prospective register of systematic reviews–CRD42020154395.
Purpose of review
It is important to identify factors that contribute to postpartum changes in sexual function and identify women at high risk for more persistent, impaired sexual response. The aim of this review was to review recent research to evaluate the relationship between depression and sexual function in the postpartum period.
Recent findings
The databases of PubMed, PsychINFO, and OVID Medline were searched for relevant articles. After review for eligibility criteria, 34 articles were reviewed. Studies showed depression was related to lower sexual function in postpartum women and impairments in sexual function and mood persisted beyond the traditional 12-month postpartum period. However, several studies with multivariate models indicated that depression and sexual function did not remain significantly related, though subjective elements of sexuality (e.g., sexual satisfaction) remained associated with depression. Several studies did not find a significant association between sexual pain and depression, though catastrophizing thoughts and sexual distress were significant. Studies highlighted the role of relationship satisfaction and partner support in the association between sexual function and depression.
Summary
The biopsychosocial model appears appropriate when assessing and managing postpartum sexual function. Results highlight the importance of screening for depression and sexual function beyond the typical initial postpartum visit, even two to 18 years past childbirth. Subjective elements of sexual function, including sexual distress and satisfaction are important to assess. Providers may consider including partners in management of postpartum depression and sexual dysfunction, as partner support was often a protective factor. Longitudinal research studies accounting for pre-pregnancy levels of sexual function and depression are needed. Studies focusing on women diagnosed with depression, with perinatal complications, and trauma symptoms are needed. Measures of sexual function could be validated in postpartum women to identify cutpoints specific to this population.
This review attempts to explore the traditional postnatal practices based on cultural beliefs and evidence-based benefits. This narrative review involved published quantitative and qualitative studies, review papers and guidelines and review documents by the Ministry of Health Malaysia. A literature search was conducted by using these databases-Medline, Science Direct and Google Scholar. There are some evidences to support some of the postnatal practices in providing physical and psychological benefits to postpartum mothers. For example, postnatal body massage could reduce anxiety and postnatal depression. Breast massage caused a reduction in breast pain from breast engorgement and improved lactation. A hot compress could reduce breast pain and prevent postpartum weight retention. These findings are essential for healthcare providers to support or refute the traditional postnatal practices and allow better integration of traditional postnatal practices into modern medicine. More studies with good research design are needed to evaluate the effectiveness and safety of the traditional postnatal practices.
Worldwide the most performed surgical intervention is cesarean section. Hence, post-Cesarean pain is a common problem with a significant health and economic impact on the individual patient and society. Adequate treatment of post Cesarean pain is necessary to facilitate enhanced recovery, improve neonatal outcome by improving breast feeding success and bonding between mother and child and by diminish pain induced side-effects. Optimal pain relief is therefore important but in the obstetric population often complex due to the interplay of mother and neonate. To facilitate recovery and to temper side-effects of potent analgesic drugs such as opioids, multimodal analgesia is currently advocated and clear international guidelines and recommendations have recently been described. In the present overview we will discuss the most recent guidelines and we will evaluate various analgesic interventions.
Objectives:
Pregnancy and vaginal delivery are risk factors for pelvic floor dysfunction. Abdominal binder use may increase intraabdominal pressure, affecting pelvic floor healing or function in recently traumatized postpartum pelvic floor muscle. This study assesses the prevalence of postpartum abdominal binder use, timing, and reasons for use.
Methods:
In this cross-sectional observational survey study, women who underwent a vaginal delivery at our institution were enrolled. Participants were excluded if they did not speak Spanish or English. Participants were recruited on the postpartum unit. Data were deidentified and analyzed as appropriate for each variable.
Results:
In total, 673 surveys were completed. Seven were excluded because they had cesarean deliveries. The average age was 26 years. Median gravidity and parity were 2 and 2. In total, 549 women (82%) planned to wear an abdominal binder postpartum. In all, 335 women provided a specific time when they would start use: 240 women (71%) would start at ≤2 days postpartum, 60 women (18%) would start at 3 to 7 days postpartum, and 35 women (11%) would start after 1 week postpartum. Common reasons reported for use included appearance, support, pain, swelling, weight loss, and recommendation.
Conclusions:
Among women delivering at our institution, planned abdominal binder use postvaginal delivery is common. The reasons cited include health and desire to return to prior body shape. The effects of using an abdominal binder in the postpartum period are unknown. More research is needed to better elucidate how increased postpartum intraabdominal pressure affects healing in traumatized pelvic floor muscles.
Objective Silver dressings have been associated with a decrease in postoperative pain in selected populations, but it is unknown if the benefit can be observed after cesarean deliveries. We sought to evaluate the impact of silver nylon dressings in reducing postoperative pain after cesarean delivery.
Study Design A secondary analysis of data from a blinded randomized clinical trial of women undergoing cesarean delivery scheduled and unscheduled at a single site was conducted. Women were recruited for participation from a single site and randomized to a silver nylon dressing or an identical-appearing gauze wound dressing. Wounds were evaluated in the outpatient clinic at 1 and 6 weeks after delivery and patient responded to the modified patient scar assessment scale. The primary outcome of this analysis was inpatient opioid and nonopioid analgesic dispensed. The secondary outcome was patient-reported pain at the 1- and 6-week postpartum visits. Data were analyzed using chi-square test, Student's t-test, Fisher's exact test, Wilcoxon–Mann–Whitney's test, and logistic regression where appropriate. A p-value of < 0.05 was considered significant.
Results Among the 649 participants, women allocated to the silver nylon dressing group, when compared with the gauze group, were similar in the amount of dispensed opioid and nonopioid analgesic medications (morphine equivalent milligrams of opioids dispensed [82.5 vs. 90 mg, p = 0.74], intravenous nonsteroidal anti-inflammatory drugs (NSAIDs) [120 vs. 120 mg, p = 0.55], and oral NSAIDs [4,800 vs. 5,600 mg in the gauze group, p = 0.65]). After adjusting for confounding variables, postoperative wound infection (adjusted odds ratio [aOR]: 11.70; 95% confidence interval [CI]: 4.51–30.31) at 1-week postoperative and again at 6-week postoperative (aOR: 5.59; 95% CI: 1.03–30.31) but not gauze dressing was associated with patient-reported postoperative pain.
Conclusion Among women undergoing cesarean delivery, silver nylon dressing was not associated with a reduction in postoperative pain.
Key Points
Objective. We conducted a meta-analysis to quantitatively evaluate the effects of abdominal binder in abdominal surgeries. Methods. Through literature retrieval in globally recognized databases (MEDLINE, EMBASE, and Cochrane Central), trials investigating the application of abdominal binder in abdominal surgeries were systematically reviewed. The main outcomes, namely, 6-minute walk test (6MWT), visual analog scale (VAS) pain score, and symptom distress scale (SDS) score, were pooled to make an overall estimation. I ² index was calculated to identify heterogeneity, and sensitivity analysis was performed to validate the stability of main results and explore the source of heterogeneity. A funnel plot and Egger’s test were applied to assess publication bias. Results. Ten randomized controlled trials consisting of 968 subjects were ultimately included for the pooled estimation. Abdominal binder significantly increased the distance of 6MWT with standard mean difference (SMD) of .555 ( P < .001) and decreased the scores of VAS and SDS with SMD of −.979 ( P < .001) and −.716 ( P < .001), respectively. Despite of the significant heterogeneity indicated by I ² index statistic, the results of sensitivity analysis revealed the reliability of the main conclusions. While we identified no obvious publication bias regarding 6MWT (Egger’s test P = .321), it seemed that significant publication biases existed with respect to the estimation of VAS ( P < .001) and SDS ( P = .006). Conclusion. The current meta-analysis verified that abdominal binder efficiently promoted recovery after abdominal surgeries in terms of facilitating mobilization, alleviating pain, and reducing postoperative distress. More rigorously designed clinical trials with large sample size are expected to further elaborate its clinical value.
Background
Pain after caesarean sections (CS) can affect the well‐being of the mother and her ability with her newborn. Conventional pain‐relieving strategies are often underused because of concerns about the adverse maternal and neonatal effects. Complementary alternative therapies (CAM) may offer an alternative for post‐CS pain.
Objectives
To assess the effects of CAM for post‐caesarean pain.
Search methods
We searched Cochrane Pregnancy and Childbirth’s Trials Register, LILACS, PEDro, CAMbase, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) (6 September 2019), and checked the reference lists of retrieved articles.
Selection criteria
Randomised controlled trials (RCTs), including quasi‐RCTs and cluster‐RCTs, comparing CAM, alone or associated with other forms of pain relief, versus other treatments or placebo or no treatment, for the treatment of post‐CS pain.
Data collection and analysis
Two review authors independently performed study selection, extracted data, assessed risk of bias and assessed the certainty of evidence using GRADE.
Main results
We included 37 studies (3076 women) which investigated eight different CAM therapies for post‐CS pain relief. There is substantial heterogeneity among the trials. We downgraded the certainty of evidence due to small numbers of women participating in the trials and to risk of bias related to lack of blinding and inadequate reporting of randomisation processes. None of the trials reported pain at six weeks after discharge.
Primary outcomes were pain and adverse effects, reported per intervention below. Secondary outcomes included vital signs, rescue analgesic requirement at six weeks after discharge; all of which were poorly reported, not reported, or we are uncertain as to the effect
Acupuncture or acupressure
We are very uncertain if acupuncture or acupressure (versus no treatment) or acupuncture or acupressure plus analgesia (versus placebo plus analgesia) has any effect on pain because the quality of evidence is very low. Acupuncture or acupressure plus analgesia (versus analgesia) may reduce pain at 12 hours (standardised mean difference (SMD) ‐0.28, 95% confidence interval (CI) ‐0.64 to 0.07; 130 women; 2 studies; low‐certainty evidence) and 24 hours (SMD ‐0.63, 95% CI ‐0.99 to ‐0.26; 2 studies; 130 women; low‐certainty evidence).
It is uncertain whether acupuncture or acupressure (versus no treatment) or acupuncture or acupressure plus analgesia (versus analgesia) has any effect on the risk of adverse effects because the quality of evidence is very low.
Aromatherapy
Aromatherapy plus analgesia may reduce pain when compared with placebo plus analgesia at 12 hours (mean difference (MD) ‐2.63 visual analogue scale (VAS), 95% CI ‐3.48 to ‐1.77; 3 studies; 360 women; low‐certainty evidence) and 24 hours (MD ‐3.38 VAS, 95% CI ‐3.85 to ‐2.91; 1 study; 200 women; low‐certainty evidence). We are uncertain if aromatherapy plus analgesia has any effect on adverse effects (anxiety) compared with placebo plus analgesia.
Electromagnetic therapy
Electromagnetic therapy may reduce pain compared with placebo plus analgesia at 12 hours (MD ‐8.00, 95% CI ‐11.65 to ‐4.35; 1 study; 72 women; low‐certainty evidence) and 24 hours (MD ‐13.00 VAS, 95% CI ‐17.13 to ‐8.87; 1 study; 72 women; low‐certainty evidence).
Massage
We identified six studies (651 women), five of which were quasi‐RCTs, comparing massage (foot and hand) plus analgesia versus analgesia. All the evidence relating to pain, adverse effects (anxiety), vital signs and rescue analgesic requirement was very low‐certainty.
Music
Music plus analgesia may reduce pain when compared with placebo plus analgesia at one hour (SMD ‐0.84, 95% CI ‐1.23 to ‐0.46; participants = 115; studies = 2; I2 = 0%; low‐certainty evidence), 24 hours (MD ‐1.79, 95% CI ‐2.67 to ‐0.91; 1 study; 38 women; low‐certainty evidence), and also when compared with analgesia at one hour (MD ‐2.11, 95% CI ‐3.11 to ‐1.10; 1 study; 38 women; low‐certainty evidence) and at 24 hours (MD ‐2.69, 95% CI ‐3.67 to ‐1.70; 1 study; 38 women; low‐certainty evidence). It is uncertain whether music plus analgesia has any effect on adverse effects (anxiety), when compared with placebo plus analgesia because the quality of evidence is very low.
Reiki
We are uncertain if Reiki plus analgesia compared with analgesia alone has any effect on pain, adverse effects, vital signs or rescue analgesic requirement because the quality of evidence is very low (one study, 90 women).
Relaxation
Relaxation may reduce pain compared with standard care at 24 hours (MD ‐0.53 VAS, 95% CI ‐1.05 to ‐0.01; 1 study; 60 women; low‐certainty evidence).
Transcutaneous electrical nerve stimulation
TENS (versus no treatment) may reduce pain at one hour (MD ‐2.26, 95% CI ‐3.35 to ‐1.17; 1 study; 40 women; low‐certainty evidence). TENS plus analgesia (versus placebo plus analgesia) may reduce pain compared with placebo plus analgesia at one hour (SMD ‐1.10 VAS, 95% CI ‐1.37 to ‐0.82; 3 studies; 238 women; low‐certainty evidence) and at 24 hours (MD ‐0.70 VAS, 95% CI ‐0.87 to ‐0.53; 108 women; 1 study; low‐certainty evidence).
TENS plus analgesia (versus placebo plus analgesia) may reduce heart rate (MD ‐7.00 bpm, 95% CI ‐7.63 to ‐6.37; 108 women; 1 study; low‐certainty evidence) and respiratory rate (MD ‐1.10 brpm, 95% CI ‐1.26 to ‐0.94; 108 women; 1 study; low‐certainty evidence).
We are uncertain if TENS plus analgesia (versus analgesia) has any effect on pain at six hours or 24 hours, or vital signs because the quality of evidence is very low (two studies, 92 women).
Authors' conclusions
Some CAM therapies may help reduce post‐CS pain for up to 24 hours. The evidence on adverse events is too uncertain to make any judgements on safety and we have no evidence about the longer‐term effects on pain.
Since pain control is the most relevant outcome for post‐CS women and their clinicians, it is important that future studies of CAM for post‐CS pain measure pain as a primary outcome, preferably as the proportion of participants with at least moderate (30%) or substantial (50%) pain relief. Measuring pain as a dichotomous variable would improve the certainty of evidence and it is easy to understand for non‐specialists. Future trials also need to be large enough to detect effects on clinical outcomes; measure other important outcomes as listed lin this review, and use validated scales.
Objective
To evaluate the effectiveness of a postnatal dynamic elastomeric fabric orthoses to manage postpartum pain, improve functional capacity and enhance the quality of life arising from postnatal ailments immediately to an 8-week postpartum, compared with patients who did not wear dynamic elastomeric fabric orthoses.
Method
A total of 51 postpartum women were recruited (day 0 to 10 days post-delivery) from hospitals and community-based health clinics to participate in a prospective quasi-experimental controlled study using parallel groups without random allocation. The subgroup of the compression shorts group wore SRC recovery shorts and received standard postnatal care. The comparison group received standard postnatal care alone. Wear compliance was monitored throughout the study. Primary outcome measure, Numeric Pain Rating Scale, and secondary outcome measures, Roland Morris Disability Questionnaire, Pelvic Floor Impact Questionnaire–7, and Short Form (SF-36) were assessed fortnightly over 8 weeks for both groups.
Results
The compression shorts group reported a larger reduction in mean (SD) Numeric Pain Rating Scale score (−3.09 (2.20)) from baseline to 8 weeks, compared to the comparison group (−2.00 (1.41)). However, there was insufficient evidence of a statistical difference in Numeric Pain Rating Scale score at 8 weeks when comparing the compression shorts group and comparison group (−1.17; 95%CI: (−2.35, −0.01), R ² = .19, p = .050). The compression shorts group met the wear compliance of the dynamic elastomeric fabric orthoses and reported an average wear of the dynamic elastomeric fabric orthoses as 9 out of 14 days for 11 h per day (SD 4.8 h) between the fortnightly timepoints.
Conclusion
The use of dynamic elastomeric fabric orthoses may be considered during postnatal care as a non-pharmacological therapeutic intervention to manage pain resulting from common postpartum ailments. While the dynamic elastomeric fabric orthoses was clinically well accepted by participants with high wearing compliance, future research with larger population samples are needed to enable statistical conclusions on the effectiveness of a dynamic elastomeric fabric orthoses in postnatal care to be made.
Registration
Trial registration was not required as per the Australian Government Department of Health, Therapeutic Goods Administration.
The Elastic abdominal binder has been widely employed by clinicians for pain relief, wound complications prevention, improved pulmonary function, and stabilisation. However, these proposed benefits have not been properly examined in women following caesarean delivery. We aimed to examine the effects of post-caesarean elastic abdominal binder use on recovery by comparing post-operative pain, mobility and quality of life. Pregnant women undergoing caesarean delivery were randomly assigned into two groups: abdominal binder (90 patients) and control (90 patients). The primary outcomes included the daily visual analogue scale pain scores and the distance from the six-minute walk test. Baseline characteristics were similar between the groups. There was no significant difference in pain scores and six-minute walking distance between the study groups. There was no significant between-group difference in quality-of-life dimensions, overall health status, and post-operative complication. The positive effects of elastic abdominal binder use following caesarean delivery could not be demonstrated in this study.
• Impact statement
• What is already known on this subject? Elastic abdominal binder is commonly used after laparotomy to support incision. There was evidence to support the benefit of abdominal binder in reducing psychological distress during the first five days following laparotomy for other indications. From limited number of studies addressing caesarean section, the evidence for the benefits of the binder on pain, symptom distress, and change in haemoglobin level is conflicting.
• What do the results of this study add? In contrast to the results of the previous study, the beneficial effects of abdominal binder on pain reduction, functional recovery, and quality of life following caesarean delivery could not be demonstrated in this study.
• What are the implications of these findings for clinical practice and/or further research? The use of elastic abdominal binder after caesarean delivery is not associated with reduction of postoperative pain, faster functional recovery, and improved quality of life in our population. Further studies in other population with different characteristics may be worthwhile.
Background and aim:
The use of abdominal binders after laparotomy is a question of habit. Scientific evidence of their usefulness is limited. The aims of this work were to review the scientific literature and to depict the practices of French surgeons regarding the use of these devices.
Methods:
A systematic review of the literature about the use of abdominal binders after laparotomy was conducted. In order to depict surgeons' habits, an anonymous questionnaire was sent to all surgical departments affiliated to the FRENCH network (Federation of Surgical Research) and their surgical contacts. They were all asked about their use of binders, the type of binders they ordered, the expected benefit, the cost and the need for a randomized trial in this field.
Results:
Only four trials have been published regarding the use of abdominal binders after laparotomy, all with a small number of patients. Some authors suggested that wearing binders procured a benefit in terms of postoperative comfort, but no significant difference was found. One study also suggested an improvement in respiratory volumes. No study focused on incisional hernia. Regarding the survey of practices, 50 questionnaires were retained for the final analysis (one questionnaire per department of surgery). The use of this device is really very frequent in France (94 % of surgeons order them), a habit usually acquired during the training in surgery. The main expected benefit is the prevention of abdominal wall dehiscence (83 %), but also an improvement in patients' postoperative comfort and pain (66 %). Although some surgeons order an abdominal binder for all their patients, most use them in selected patients (according to the operation and the patients' characteristics).
Conclusion:
Abdominal binders are frequently ordered by French surgeons after laparotomy. The expected benefit is the prevention of abdominal-wall complications, even though no data actually support this practice. Binders might have a benefit in terms of postoperative pain relief, but this needs to be analyzed. A prospective randomized trial is warranted.
Purpose:
Application of an abdominal binder is often part of a standard postoperative regimen after ventral hernia repair to reduce pain and seroma formation. However, there is lack of evidence of the clinical effects. The aim of the present study was to investigate the pain- and seroma-reducing effect of an abdominal binder in patients undergoing laparoscopic umbilical or epigastric hernia repair.
Methods:
Based on power analysis, a minimum of 54 patients undergoing laparoscopic umbilical and epigastric hernia repair were to be included. Patients were randomized to abdominal binders vs. no abdominal binders during the first postoperative week. Standardized surgical technique, anaesthesia, and analgesic regimens were used and study observers were blinded towards the intervention. Postoperative pain (visual analogue score) on day 1 was the primary outcome. In addition, ultrasonographic evaluation of seroma formation and several subjective patient-related parameters were registered. Furthermore, patients in the abdominal binder group were asked to rate benefits or discomforts of wearing the binder.
Results:
Data from 56 patients (abdominal binder, n = 28; no binder, n = 28) were available for analysis. No significant intergroup differences in postoperative pain or any of the other surgical outcomes, including seroma formation, were found. However, the abdominal binder group reported subjective beneficial effect of wearing the binder in 24 of the 28 patients (86%). No adverse effects of the abdominal binder were found.
Conclusions:
There were no effects of an abdominal binder on pain, movement limitation, fatigue, seroma formation, general well-being, or quality of life. However, most patients claimed a subjective beneficial effect of using their abdominal binder.
Background:
Data for the causes of maternal deaths are needed to inform policies to improve maternal health. We developed and analysed global, regional, and subregional estimates of the causes of maternal death during 2003-09, with a novel method, updating the previous WHO systematic review.
Methods:
We searched specialised and general bibliographic databases for articles published between between Jan 1, 2003, and Dec 31, 2012, for research data, with no language restrictions, and the WHO mortality database for vital registration data. On the basis of prespecified inclusion criteria, we analysed causes of maternal death from datasets. We aggregated country level estimates to report estimates of causes of death by Millennium Development Goal regions and worldwide, for main and subcauses of death categories with a Bayesian hierarchical model.
Findings:
We identified 23 eligible studies (published 2003-12). We included 417 datasets from 115 countries comprising 60 799 deaths in the analysis. About 73% (1 771 000 of 2 443 000) of all maternal deaths between 2003 and 2009 were due to direct obstetric causes and deaths due to indirect causes accounted for 27·5% (672 000, 95% UI 19·7-37·5) of all deaths. Haemorrhage accounted for 27·1% (661 000, 19·9-36·2), hypertensive disorders 14·0% (343 000, 11·1-17·4), and sepsis 10·7% (261 000, 5·9-18·6) of maternal deaths. The rest of deaths were due to abortion (7·9% [193 000], 4·7-13·2), embolism (3·2% [78 000], 1·8-5·5), and all other direct causes of death (9·6% [235 000], 6·5-14·3). Regional estimates varied substantially.
Interpretation:
Between 2003 and 2009, haemorrhage, hypertensive disorders, and sepsis were responsible for more than half of maternal deaths worldwide. More than a quarter of deaths were attributable to indirect causes. These analyses should inform the prioritisation of health policies, programmes, and funding to reduce maternal deaths at regional and global levels. Further efforts are needed to improve the availability and quality of data related to maternal mortality.
Purpose:
Immobility and pain are modifiable risk factors for development of venous thromboembolism and pulmonary morbidity after major abdominal surgery (MAS). The purpose of this study was to investigate the effect of abdominal incision support with an elasticized abdominal binder on postoperative walk performance (mobility), perceived distress, pain, and pulmonary function in patients following MAS.
Methods:
Seventy-five patients scheduled to undergo MAS via laparotomy were randomized to experimental (binder) or control (no binder) groups. Sixty (33 male, 27 female; mean age 58±14.9 years) completed the study. Preoperative measurements of 6-minute walk test (6MWT) distance, perceived distress, pain, and pulmonary function were repeated 1, 3, and 5 days after surgery.
Results:
Surgery was associated with marked postoperative reductions (p<0.001) in walk distance (∼75-78%, day 3) and forced vital capacity (35%, all days) for both groups. Improved 6MWT distance by day 5 was greater (p<0.05) for patients wearing a binder (80%) than for the control group (48%). Pain and symptom-associated distress remained unchanged following surgery with binder usage, increasing significantly (p<0.05) only in the no binder group.
Conclusion:
Elasticized abdominal binders provide a non-invasive intervention for enhancing recovery of walk performance, controlling pain and distress, and improving patients' experience following MAS.
Background
Each year, worldwide about 530,000 women die from causes related to pregnancy and childbirth. Of the deaths 99% are in low and middle income countries. Obstetric haemorrhage is the leading cause of maternal mortality, most occurring in the postpartum period. Systemic antifibrinolytic agents are widely used in surgery to prevent clot breakdown (fibrinolysis) in order to reduce surgical blood loss. At present there is little reliable evidence from randomised trials on the effectiveness of tranexamic acid in the treatment of postpartum haemorrhage.
Methods
The Trial aims to determine the effect of early administration of tranexamic acid on mortality, hysterectomy and other morbidities (surgical interventions, blood transfusion, risk of non-fatal vascular events) in women with clinically diagnosed postpartum haemorrhage. The use of health services and safety, especially thromboembolic effect, on breastfed babies will also be assessed. The trial will be a large, pragmatic, randomised, double blind, placebo controlled trial among 15,000 women with a clinical diagnosis of postpartum haemorrhage. All legally adult women with clinically diagnosed postpartum haemorrhage following vaginal delivery of a baby or caesarean section will potentially be eligible. The fundamental eligibility criterion is the responsible clinician's 'uncertainty' as to whether or not to use an antifibrinolytic agent in a particular woman with postpartum haemorrhage. Treatment will entail a dose of tranexamic acid (1 gram by intravenous injection) or placebo (sodium chloride 0.9%) will be given as soon as possible after randomisation. A second dose may be given if after 30 minutes bleeding continues, or if it stops and restarts within 24 hours after the first dose.
The main analyses will be on an 'intention to treat' basis, irrespective of whether the allocated treatment was received or not. Subgroup analyses for the primary outcome will be based on type of delivery; administration or not of prophylactic uterotonics; and on whether the clinical decision to consider trial entry was based primarily on estimated blood loss alone or on haemodynamic instability. A study with 15,000 women will have over 90% power to detect a 25% reduction from 4% to 3% in the primary endpoint of mortality or hysterectomy.
Trial registration
Current Controlled Trials: ISRCTN76912190 and Clinicaltrials.gov ID: NCT00872469
Pain has significant socioeconomic, health, and quality-of-life implications. Racial- and ethnic-based differences in the pain care experience have been described. Racial and ethnic minorities tend to be undertreated for pain when compared with non-Hispanic Whites.
To provide health care providers, researchers, health care policy analysts, government officials, patients, and the general public with pertinent evidence regarding differences in pain perception, assessment, and treatment for racial and ethnic minorities. Evidence is provided for racial- and ethnic-based differences in pain care across different types of pain (i.e., experimental pain, acute postoperative pain, cancer pain, chronic non-malignant pain) and settings (i.e., emergency department). Pertinent literature on patient, health care provider, and health care system factors that contribute to racial and ethnic disparities in pain treatment are provided.
A selective literature review was performed by experts in pain. The experts developed abstracts with relevant citations on racial and ethnic disparities within their specific areas of expertise. Scientific evidence was given precedence over anecdotal experience. The abstracts were compiled for this manuscript. The draft manuscript was made available to the experts for comment and review prior to submission for publication.
Consistent with the Institute of Medicine's report on health care disparities, racial and ethnic disparities in pain perception, assessment, and treatment were found in all settings (i.e., postoperative, emergency room) and across all types of pain (i.e., acute, cancer, chronic nonmalignant, and experimental). The literature suggests that the sources of pain disparities among racial and ethnic minorities are complex, involving patient (e.g., patient/health care provider communication, attitudes), health care provider (e.g., decision making), and health care system (e.g., access to pain medication) factors. There is a need for improved training for health care providers and educational interventions for patients. A comprehensive pain research agenda is necessary to address pain disparities among racial and ethnic minorities.
( Int J Gynaecol Obstet . 2016;133(2):188–191)
Many patients who have undergone cesarean delivery prefer nonpharmacological interventions, such as abdominal compression devices, for pain management. However, the use of these interventions is currently based on preference with little or no evidence-based supporting data. The authors of the present study thus evaluated the effectiveness of an abdominal binder on managing post-cesarean delivery pain and distress in patients.
Objective:
To determine whether abdominal binders effectively control pain and distress after cesarean delivery.
Methods:
A prospective randomized controlled trial was conducted between April and November, 2014, among women undergoing cesarean delivery (low-transverse skin incision) at two US hospitals. Participants were randomly allocated to either the abdominal binder or control groups on entry to the operating suite. Masking was not possible. Patients in the abdominal binder group were fitted with a device before leaving the operating room and were encouraged to wear it constantly, although breaks were allowed. The primary outcomes were postoperative distress (measured by the Symptom Distress Scale [SDS]) and pain (measured by a visual analog scale [VAS]). Individuals who asked to be removed from the study within 6hours of surgery were excluded from analyses.
Results:
Analyses included 87 patients in the abdominal binder group and 68 in the control group. The abdominal binder and control groups did not differ in postoperative day 1 VAS (3.1±2.1 vs 3.4±2.3; P=0.33), postoperative day 2 VAS (3.0±1.9 vs 3.8±2.2; P=0.16), postoperative day 1 SDS (21.5±5.4 vs 21.8±5.1; P=0.87), and postoperative day 2 SDS (19.4±4.8 vs 19.9±5.0; P=0.53).
Conclusion:
Postoperative pain and distress scores after cesarean delivery were not affected by abdominal binders. ClinicalTrials.gov:NCT02129894.
Patients delivered by cesarean are a unique subset of postoperative patients with possible complications that include postpartum hemorrhage and pain. A potential nonpharmacologic way to reduce these complications is with an abdominal binder: a soft, elastic band that can provide circumferential compression on the wound.
Patients scheduled for cesarean delivery were randomized to receive a binder or to a control group (no binder). Pain levels were reported by questionnaire 1 day after surgery using a 0-10 scale. Patient characteristics and blood loss were assessed by medical record review. An intention-to-treat analysis was conducted despite the fact that four patients in the control group received a binder.
Of the 56 patients completing the study, 29 (51.8%) were randomized to the binder group and 27 (48.2%) were randomized to the control group. Indications for cesarean delivery were previous cesarean delivery (n=50, 89.3%) or breech presentation (n=6, 10.7%). Most patients received an epidural (n=55, 98.2%). There was no difference in body mass index, age, previous surgery, neonatal birth weight, or estimated blood loss between randomization groups. Lowest pain score (1.66 compared with 2.56 for the binder and control groups, respectively, P=.019) and average pain score (3.45 compared with 4.48 for the binder and control groups, respectively, P=.024) were significantly lower in the treatment group. There was no difference in preoperative and postoperative hemoglobin levels by treatment group.
Abdominal binders improved pain scores but did not affect postoperative hemorrhage. As a result of the small sample size, further confirmation of these outcomes is desirable.
Introduction:
Evidence for the effect of post-operative abdominal binders on post-operative pain, seroma formation, physical function, pulmonary function and increased intra-abdominal pressure among patients after surgery remains largely un-investigated.
Methods:
A systematic review was conducted. The PubMed, EMBASE and Cochrane databases were searched for studies on the use of abdominal binders after abdominal surgery or abdominoplasty. All types of clinical studies were included. Two independent assessors evaluated the scientific quality of the studies. The primary outcomes were pain, seroma formation and physical function.
Results:
A total of 50 publications were identified; 42 publications were excluded leaving eight publications counting a total of 578 patients for analysis. Generally, the scientific quality of the studies was poor. Use of abdominal binder revealed a non-significant tendency to reduce seroma formation after laparoscopic ventral herniotomy and a non-significant reduction in pain. Physical function was improved, whereas evidence supports a beneficial effect on psychological distress after open abdominal surgery. Evidence also supports that intra-abdominal pressure increases with the use of abdominal binders. Reduction of pulmonary function during use of abdominal binders has not been revealed.
Conclusion:
Abdominal binders reduce post-operative psychological distress, but their effect on post-operative pain after laparotomy and seroma formation after ventral hernia repair remains unclear. Due to the sparse evidence and poor quality of the literature, solid conclusions may be difficult to make, and procedure-specific, high-quality randomised clinical trials are warranted.
Abdominal binders are ordered by some surgeons postoperatively for patient comfort and to prevent wound complications. There has been some question as to the compressive effect that an abdominal binder has on pulmonary function. We prospectively randomized 54 patients undergoing a midline laparotomy incision to two groups: a "binder" group and a "no binder" group. Preoperative pulmonary function tests (vital capacity and incentive spirometry) were measured. Postoperatively, pulmonary function tests, pulse oximetry, oxygen requirement, pulmonary and wound complications, pain control, time to ambulation, and hospital length of stay were examined. Vital capacity as a per cent of preoperative values on postoperative Day 1 for the binder and nonbinder groups were 64.7 and 54.6 per cent, respectively, but this was not statistically significant. Average level of pain using the visual analog pain scale on postoperative Days 1 through 3 in the binder versus nonbinder groups was 4 versus 8, 3 vs 6, and 3 versus 7, respectively. Time to ambulation was 18.6 hours in the binder group and 16.7 hours in the nonbinder group. Hospital length of stay in the binder and nonbinder groups was 3.9 days and 3.7 days, respectively. We conclude that abdominal binders in our patients with midline abdominal incisions had no significant effect on postoperative pulmonary function, but seemed to help with pain control.
In order to elucidate the circulatory and respiratory effects of a newly developed abdominal compression binder 25 healthy, normal weight subjects were studied. In supine position the central haemodynamics were measured and estimated with a Finapress device. Lower extremity venous haemodynamics were measured in supine position with venous occlusion plethysmography. In an upright-seated position arterial oxygen saturation was measured by a pulseoxymeter for 1 h before spirometry was performed with a turbine flow measurement device. All the tests were performed in a randomized order with or without the abdominal compression binder. The results show that the compression binder significantly increases the venous volume in the lower extremities as showed by a reduction in the venous capacitance in the lower extremities and a reduction in the stroke volume and cardiac output, while it does not influence the pulmonary volumes.
It is concluded that the applied abdominal binder significantly affects peripheral and central haemodynamics. It should therefore be used with caution when in the supine position for longer periods, as the pooling of blood it induces in the lower extremities may have implications for the risk of deep venous thrombosis formation.
Symptom distress was defined as the degree of discomfort reported by the patient in relation to his/her perception of the symptoms being experienced. The ten symptoms included in the symptom distress scale were nausea, mood, appetite, insomnia, pain, mobility, fatigue, bowel pattern, concentration and appearance. The scale was tested on fifty-three patients with advanced medical conditions. Total symptom distress scores for these patients ranged from ten to forty-one; the mean was twenty. The reliability coefficient alpha was .82143 and the standardized alpha was .82557. More testing of the scale is needed, especially with different types of chronic diseases and visible signs of illness.
Symptom distress in the adult population with cancer is of concern to clinicians who care for these patients. Increased research has been directed toward the development and refinement of symptom distress scales, the identification of determinants of symptom distress, the investigation of symptom distress as a predictor, and the examination of the relationship between quality of life and symptom distress. Findings from this research have increased our understanding of symptom distress in adult patients with cancer. However, a major limitation of work to date has been a lack of consensus related to the definition and measurement of the symptom distress construct. The purpose of this article is to address existing conceptual and methodological challenges inherent in the study of symptom distress, and to make recommendations for further research in this area.
This study aimed at examining factors related to osteoarthritis (OA) symptom severity in African American and Caucasian veterans (n=202).
OA symptom severity (lower extremity pain, stiffness, and physical function) was measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). We also examined whether racial differences existed when controlling for other important demographic and clinical variables, including age, gender, income, educational level, employment status, marital status, number of years with OA symptoms, location of arthritic joints (hip, knee, back, foot/ankle), use of exercise, and current use of OA medications. Lastly, we examined whether factors associated with self-reported OA symptom severity differed in African American and Caucasian veterans.
The mean WOMAC score for African American veterans (on a scale of 0-96) was 54.6 (SD=17.2), and the mean score for Caucasian veterans was 48.4 (SD=17.6; p=0.02). In a multivariable regression model including demographic and clinical variables, African American veterans had significantly higher WOMAC scores than Caucasians (3=0.185, p=0.009). In Caucasian veterans, greater number of years with OA, presence of hip OA, and a low income were associated with greater WOMAC scores. In African Americans, no use of exercise and the presence of OA in the hip or back were associated with greater WOMAC scores.
Among this sample of veterans, African Americans had significantly higher WOMAC scores than Caucasians after controlling for other important demographic and clinical factors. Different and more intense treatment strategies may be needed for African American veterans with OA.
Unlabelled:
Researchers have demonstrated that certain types of pain coping are correlated with less pain severity and disability and that there are differences between Caucasians and African-American pain patients in their use of specific coping strategies. However, the extent to which racial group differences exist in the associations between pain coping strategies and pain severity, interference, and disability is unclear. Furthermore, the role of education in these associations is uncertain. We recruited a diverse community sample of individuals with chronic pain and their spouses to examine this issue (N = 105). Participants completed the Coping Strategies Questionnaire, Multidimensional Pain Inventory, and Sickness Impact Profile. Results showed that African-American participants reported significantly more pain severity, interference, and disability and reported using diverting attention and prayer and hoping pain-coping strategies significantly more often than Caucasian participants; however, only the racial group difference in prayer and hoping remained when controlling for education. We also examined whether race and education interacted with coping strategies in relating to pain and disability. Significant three-way interactions were found for physical and psychosocial disability, suggesting that educational level should be included in analyses exploring racial group differences. The results suggest the need for pain treatments that take into account the educational and cultural context of pain.
Perspective:
This article demonstrates that demographic variables such as race and education should be considered together when evaluating the effectiveness of coping with pain. The findings have the potential to enhance research and clinical practice with diverse groups.
Although a great variety of surgical procedures are performed on an ambulatory basis, little is known about postoperative pain experience at home after ambulatory surgery. This study was performed to assess the prevalence and course of postoperative pain in the early postoperative period after ambulatory surgery.
Over a period of 4 months, 648 patients who underwent day-case surgery were included in our study. Data were collected with interviews and questionnaires. Pain intensity was measured using a visual analog scale (VAS) during 4 days after surgery. Side effects of anesthesia and analgesia techniques were also recorded.
On the day of the operation, 26% of the patients had moderate to severe pain (defined as mean VAS >40 mm). Mean VAS-scores were greater than 40 mm in 21% on postoperative day (POD) 1, in 13% on POD 2, in 10% on POD 3, and in 9% on POD 4. Operations of nose and pharynx, abdominal operations, plastic surgery of the breasts, and orthopedic operations were the most painful procedures during the first 48 hours.
This study showed that an important number of patients still experience moderate to severe pain in the postoperative period after day-case surgery even after a 4-day period. Furthermore, the type of operation should be considered when planning postoperative analgesia for ambulatory surgery.
To study women's experience of postoperative pain and pain relief after cesarean birth and factors associated with pain assessment and the birth experience.
Descriptive patient survey. Data were collected through a questionnaire. The outcome variables were assessments of pain using a Visual Analog Scale and women's birth experience measured on a seven-point Likert scale.
Central Swedish county hospital, maternity unit.
The sample consisted of 60 women undergoing cesarean birth.
Women reported high levels of experienced pain during the first 24 hours. Seventy-eight percent of the women scored greater than or equal to 4 on the Visual Analog Scale, which can be seen as inadequately treated pain. There was no difference between elective and emergency cesarean births in the levels of pain. In spite of high levels of pain, women were pleased with the pain relief. The risk of a negative birth experience was 80% higher for women undergoing an emergency cesarean birth compared with elective cesarean birth. Postoperative pain negatively affected breastfeeding and infant care.
There is a need for individual and adequate pain treatment for women undergoing cesarean birth, as high levels of pain interfere with early infant care and breastfeeding.
The majority of the research on the various aspects of symptom management has focused on individual symptoms. However, patients with cancer often experience multiple symptoms simultaneously as a result of their disease and treatment. In 2001, symptom management researchers began to study the impact of symptom clusters on patient outcomes. Over the past 6 years, a number of conceptual reviews as well as several research studies have been published on symptom clusters in oncology patients. This paper summarizes the conceptual basis for symptom cluster research, describes two conceptual approaches to symptom cluster research, and discusses the implications of symptom clusters for quality-of-life research. The paper concludes with an enumeration of the critical considerations that need to be addressed if this area of scientific inquiry is to move forward.
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- Be Aouizerat
- M Dodd
- Cooper B Scultetus
- Ah Villavicencio
- Jl Rich
- Nm Toft
- Mh Bulow
- J Simonsen
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Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill
Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic
Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and
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