A randomized controlled study of acupuncture for pain relief during first trimester surgical termination of pregnancy performed under local analgesia

Background: Acupuncture reduces pain levels in many painful conditions. This study compared pain levels during surgical termination of first trimester pregnancy by suction evacuation (SE) under local analgesia with and without the use of acupuncture. Methods: In all, 60 nulliparous women undergoing SE before 10 weeks of gestation were randomly assigned into one of the following three groups in a 1:1:1 ratio according to a computer-generated randomization list. In the control group, women received oral diazepam 5 mg and intramuscular (i.m.) injection of pethidine 30 and 15 min, respectively, prior to SE. In the acupuncture group, women received acupuncture 10 min before SE until the end of SE while oral diazepam 5 mg and i.m. injection of normal saline were given. In the combined group, women received acupuncture in addition to the drugs in the control group. Data from 52 participants were analysed. Pain scores during and after SE, post-operative side-effects and satisfaction levels were compared. Results: The three groups had similar baseline characteristics. The median pain levels during SE differed significantly between the control, acupuncture, and combined groups (80, 50 and 66 mm, respectively, p = 0.03). Pain levels during SE in the acupuncture and combined groups were significantly lower than that of the control group. However, the anxiety scores did not differ between the three groups after SE (p = 0.86). Conclusion: Acupuncture can provide additional benefit in terms of pain relief in women undergoing first trimester termination of pregnancy by SE under local analgesia.

Preemptive local analgesia at vaginal hysterectomy: a systematic review

Introduction and hypothesis We conducted a systematic review of the effectiveness of local preemptive analgesia for postoperative pain control in women undergoing vaginal hysterectomy. Methods MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews were searched systematically to identify eligible studies published through September 25, 2019. Only randomized controlled trials and systematic reviews addressing local preemptive analgesia compared to placebo at vaginal hysterectomy were considered. Data were extracted by two independent reviewers. Results were compared, and disagreement was resolved by discussion. Forty-seven studies met inclusion criteria for full-text review. Four RCTs, including a total of 197 patients, and two SRs were included in the review. Results Preemptive local analgesia reduced postoperative pain scores up to 6 h and postoperative opioid requirements in the first 24 h after surgery. Conclusion Preemptive local analgesia at vaginal hysterectomy results in less postoperative pain and less postoperative opioid consumption.

EP.FRI.623 Outcome of Rectus Sheath Catheters for Post Operative Analgesia in Patients Undergoing Laparotomies and Elective Colorectal Resections

Aims Multimodal analgesia combining regional and local analgesia and avoiding opioids are part of most ERAS protocols aiming to achieve good pain relief. We aim to examine the effectiveness of using rectus sheath catheters (RCSs) for pain relief in patients undergoing laparotomy surgery and wither this have affected the postoperative (30-day) outcome and the need of opioids. Methods This was a retrospective study involving patients who underwent midline laparotomy surgery, including elective colorectal resections in the period between 01/07/2020 and 23/12/2020. Results A total of 71 patients were included in the study, of which 40(56.33%) had RSCs while 31(43.66%) did not. Morphine was required for 24(60%) of those with RSCs and for 18 patients (58.06%) with no RSCs. PCA was used in 5 (12.5%) of those with RSCs and in 10 (32.25%) of those without RSCs. Of patients requiring non-PCA morphine, mean total morphine doses were 6.4 in patients with RSCs and 4.89 in patients with no RSCs. Of patients with RSCs, (22.5%, 9/40) developed chest infection within 30 days (average onset at day-11) compared to (25.8%,8/31) of the other group (average onset at day-5). 20% (8/40) of the patients with RSCs had atelectasis postoperatively compared to 29.03% (9/31) of those who did not. The Average postoperative stay was 13.65 days and 21 days for those with and without RSCs, respectively. Conclusions Using RSCs did not reduce morphine usage, However, it is associated with lower incidence of chest infection and atelectasis in addition to shorter hospital stay.

A cohort study on safety for oocyte retrieval in IVF using the same 20G needle for local analgesia and retrieval. Vaginal cleaning did not add to the safety of the procedure

Aim of study: What is the effectiveness and safety of using a 20G single lumen needle (SLN) for both applying local analgesia (LA) in the vaginal vault and ovarian capsule and oocyte retrieval (OR) using a simple syringe? And will thoroughly cleaning (TC) of the vagina before reducing the risk of the puncture procedure? Using a thin SLN has been postulated to jeopardize cumulus oocyte complexes (COC). Further applying LA in the same needle without retracting the needle before OR has been claimed to harm oocyte development. Also, many clinics extensively clean the vagina before OR. Methods: We performed a retrospective cohort study including 4983 women. 877 underwent no cleaning (nonTC) of the vagina and 4106 underwent TC using NaCl. All had OR with a 20G SLN attached to a syringe for local anaesthesia and egg collection. The treatments were done in one centre during the period from January 2016 to June 2019. We studied women undergoing IVF treatment aged 18–45 years. Women had either thoroughly vaginal cleaning before OR or no cleaning depending on the physicians preferences. All women had LA using Citanest Dental Octapressin 2ml. placed in the vaginal vault in the direction of the intended puncture including in the ovarian capsule. Therefore, only one puncture was needed in both sides, left and right. All punctures were hereafter followed by OR using the same 20G SLN. Aspiration was done by a 20ml syringe handled manually by the physician. All women underwent a conventional antagonist protocol with FSH stimulation and Ovitrelle 250IU for induction or Mild Stimulation using Tamoxifen, FSH and Ovitrelle. Outcome measurement were bleeding measured by the necessity of applying compression after the puncture or infection observed up to 1 month. Results: Baseline characteristics including age, BMI and type of stimulation were comparable between the groups. In the nonTC group no infections, bleedings or abscesses were found. In the TC group there were 1 abscess observed. Intact COC was similar in the two groups as well as pregnancy rates. Conclusion: During OR in ART the use of a 20G SLN using the same needle for LA and hereafter, without changing needle in the puncture channel, continue with the egg collection (EC) is simple and safe. In this situation TC is not necessary before puncture, making the procedure more patients friendly. In women undergoing oocyte retrieval for IVF, we found the use of a 20G SLN for both applying LA and retrieving COC safe, effective and simple. Additional TC of the vagina before puncture did not add more to the safety of the procedure.

Úlcera vulvar aguda de Lipschütz: um relato de caso

Introdução: A úlcera de Lipschütz é caracterizada por úlceras vulvares dolorosas, com revestimento fibrinoso ou exsudato acinzentado. Tem predileção por pequenos lábios. O quadro é de início súbito, afetando mulheres jovens, que na maioria não iniciaram a vida sexual, e com resolução espontânea em semanas. Pode ser desencadeada por primoinfecções bacterianas e virais. O diagnóstico geralmente se dá por exclusão de outros diagnósticos mais comuns, como infecções sexualmente transmissíveis (IST), traumas e doenças autoimunes. Relato de caso: Paciente de 12 anos, encaminhada ao hospital universitário por lesão vulvar de início há uma semana, com evolução para ulceração de grandes lábios, dor e edema local, além de odor fétido, e interrogada sobre abuso sexual. Não apresentava história de febre, outros sinais e sintomas associados, uso recente de medicações ou sexarca e menarca. Mãe negava internações prévias, doenças crônicas, uso de medicações regulares ou alergias. Exame clínico da genitália feminina com edema e hiperemia em grandes lábios, úlceras associadas a tecido fibrinoso e necrótico. Hímen e região anal de aspectos preservados. Linfonodos palpáveis em cadeias inguinais bilaterais, 1-2 cm, móveis, fibroelásticos, indolores à palpação, sem sinais flogísticos. Investigação para agentes etiológicos como HIV, sífilis, hepatites B e C, herpes simples, citomegalovírus, vírus Epstein-Barr, tuberculose, toxoplasmose, SARS-CoV-2, cultura da lesão, investigações reumatológica e oftalmológica. Todos os rastreios mostraram-se negativos. Iniciou-se tratamento com corticosteroide oral (prednisona 40 mg), que levou à melhora progressiva das lesões, à redução da dor e à cicatrização das úlceras. Conclusão: Revisão sistemática a respeito da úlcera de Lipschütz que incluiu 158 casos demonstrou que a maior parte ocorria em idade inferior a 20 anos e era associada à inatividade sexual. As lesões eram de 1 a 3 cm, dolorosas, com 1 cm de largura ou mais, bem delimitadas, com centro fibrinoso e necrótico e distribuição simétrica. Havia desordem miccional e linfonodos inguinais aumentados em parte considerável dos casos. Ocorreu concomitantemente a outra doença infecciosa em 139 casos, sendo a mononucleose a mais frequentemente detectada, seguida por espécies de micoplasma. A doença foi resolvida em três semanas ou menos. A paciente em questão apresentou quadro clínico e evolução da doença compatíveis com a descrição da literatura. A úlcera de Lipschütz é um importante diagnóstico diferencial para a população pediátrica e adolescente, podendo gerar angústia e suscitando a avaliação para abuso sexual e IST. Destaca-se importância de equipe multiprofissional, além do tratamento clínico como cuidados de higiene local, analgesia, uso de anti-inflamatórios e/ou corticosteroides tópicos ou orais em caso de inflamação intensa, além do tratamento de agente infeccioso, quando identificado. O presente trabalho traz uma atualização sobre os seus principais aspectos epidemiológicos, clínicos e diagnósticos a fim de favorecer as boas práticas emsaúde.