Henrik Kehlet

..Gastrointestinal transit after colonic resection with laparoscopy or laparotomy was assessed...

..Regional anaesthesia may have specific side-effects and is without documented advantages on morbidity in this small operation...

..It is concluded that reorganisation with fewer surgical departments is required to improve outcome after major gastrointestinal surgery...

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..Laparoscopic cholecystectomy has advantages over the open procedure for postoperative pain. However, a systematic review of postoperative pain management in this procedure has not been conducted...

..Consequently, the hospital stay may be reduced to about two to four days. Preliminary studies suggest similar improvements in more complex colorectal procedures...

..The aim of this article was to update recent data on fast-track abdominal surgery and outline future strategies for research...

..Further improvement in postoperative outcome may be obtained by developments within each care principle with a specific focus on minimally invasive surgery, effective multimodal, non-opioid analgesia and pharmacological stress reduction...

..Optimization of postoperative outcome requires the application of evidence-based principles of care carefully integrated into a multimodal rehabilitation program...

..Here, we outline strategies for identification of patients at risk and for prevention and possible treatment of this important entity of chronic pain...

..Thus, shorter lengths of stay have been achieved by oral multimodal, non-opioid analgesia together with organisational optimisation of care according to the fast-track methodology...

..It is emphasized that further advances require a multi-disciplinary approach with a focus on process organization and where sufficient quantity is available to secure anaesthesiological, surgical and nursing care expertise...

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..This chapter reviews the methodology and results of PROSPECT: a public web site (www.postoppain.org) which provides information and recommendations for evidence-based procedure-specific postoperative pain management...

..Further data are needed from multi-national institutions on morbidity, safety, and costs...

..The purpose of this survey was therefore to assess current attitudes of surgeons towards the clinical impact and management of POI...

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..Surgeons and anesthesiologists should therefore adjust their anesthesia practices to fit the available scientific evidence...

..Perioperative anemia leads to increased morbidity and mortality and potentially inhibits rehabilitation after hip fracture surgery. As such, the optimum transfusion threshold after hip fracture surgery is unknown...

..The aim of this study was to investigate the effect of a similar fast track regimen in patients operated for ovarian cancer...

..Further large-scale studies are required on potential differences in serious morbidity and mortality...

..Persistent postherniotomy pain (PPP) affects everyday activities in 5-10% of patients. Identification of predisposing factors may help to identify the risk groups and guide anesthetic or surgical procedures in reducing risk for PPP...

..The purpose of this study was to assess and discuss perioperative care principles in patients undergoing ovarian cancer surgery with stage IIIC at the six centres in Denmark performing this surgical procedure...

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..There seems to be room for improvement of quality, and a plan for the next five years is presented...

..Z-score evaluation of sensory function identifies subpopulations in PPP, which may be used in selecting surgical and/or pharmacological treatment strategies...

..However, it has been speculated that a decrease in LOS may be associated with an increase in readmissions in general, including risk of dislocation after total hip arthroplasty (THA) or manipulation after total knee arthroplasty (TKA)...

..The objective of this study was to investigate the effects of 2 levels of intraoperative fluid administration on perioperative physiology and outcome after laparoscopic cholecystectomy...

..In this prospective study of 150 consecutive patients undergoing laparoscopic cholecystectomy, the preoperative clinical data, cold pressor test, state of neuroticism and early postoperative pain intensity were assessed...

..We therefore conducted a prospective study to establish whether anaemia affected functional mobility in the early post-operative phase after a hip fracture surgery...

..No serious side effects were observed for up to 6 mo after administration. In conclusion, bupivacaine incorporated in microcapsules provided analgesia for 96 h after subcutaneous infiltration...

..High-volume local infiltration analgesia has been shown to be an effective pain treatment after knee replacement, but the role of bandaging to prolong analgesia has not been evaluated...

..05). CONCLUSIONS: Time to first defecation, hospital stay, and morbidity may be reduced after colonic resection with fast-track multimodal rehabilitation...

..These guidelines will also be available at the website for the Danish Hernia Database (www.herniedatabasen.dk). The guidelines will be updated when new substantial evidence becomes available...

..There is an urgent need for better design of studies, especially in minimal invasive surgery to achieve maximal outcome effects when integrated into the fast-track methodology...

..Giving up activities was associated with pain and swelling/heaviness, younger age, ALND, chemotherapy, time elapsed since surgery, and surgery on the dominant side. Radiotherapy and type of breast surgery were of no importance...

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..Therefore, we investigated the nationwide incidence of chronic pain after lung transplantations...

..The aim of this study was to evaluate the availability and content of guidelines for perioperative care in all departments performing colonic resection, nephrectomy, ovarian cancer surgery, pulmonary resection and total knee replacement...

..The primary aim of the present study was, therefore, to evaluate the organisation and quality of current primary surgical intervention for ovarian cancer in Denmark...

..Factors other than nerve damage may be involved in the development of chronic posthemiotomy pain...

..5% of patients. However, the specific psychosexological and neurophysiologic characteristics have not been described, thereby precluding assessment of pathogenic mechanisms and treatment strategies...

..Since pre-operative pain has been demonstrated to be a risk factor for persistent postherniotomy pain, pre-operative alterations in nociceptive function may be a potential pathogenic mechanism...

..The choice between pharmacological intervention and re-exploration is debatable. A centralisation of the Danish patients with regard to evaluation and treatment is proposed...

..To evaluate the applicability, effectiveness, immediate postoperative complaints and requirements for a postanaesthesia care unit stay after elective abdominal hysterectomy under a well defined, multimodal anaesthetic regime...

..The results are in line with animal findings on the role of GABA in pain processing and with studies in humans showing analgesic efficacy of GABA-related drugs in clinical pain conditions...

..In this study we investigated the effects of two levels of intravascular fluid administration ("liberal" versus "restrictive") in knee arthroplasty on physiological recovery as the primary outcome variable...

..The pathogenic mechanisms are complex and may be related to patient characteristics, surgical technique, and adjuvant therapy...

..A multi-modal rehabilitation programme including continuous epidural analgesia with local anaesthetics, enforced nutrition and mobilisation may reduce PI to 1-2 days after colonic surgery...

..We analyze, on a nationwide basis, the risk of re-reoperation with reference to previous inguinal hernia repair technique...

..Studies of other childhood surgery before the age of 3 months suggest a risk of increased pain responsiveness later in life, but its potential relationship to chronic pain in adult life is unknown...

..We tested this hypothesis using a postoperative pain model, in conjunction with serial functional magnetic resonance imaging (fMRI)...

..However, it is unknown whether stroke volume (SV) responds to an increase in preload induced by fluid administration...

..Therefore, the authors investigated the potential of a preoperatively induced heat injury to predict subsequent postoperative pain ratings in patients undergoing knee surgery...

..High-volume infiltration analgesia may be effective in postoperative pain management after hip arthroplasty but methodological problems prevent exact interpretation of previous studies...

..The aim of our study was to describe the quality of treatment and care related to fast-track hip fracture surgery in Denmark by external audit of patient records...

..e. intraarticular or extraarticular) has not been evaluated...

..CONCLUSIONS: Addition of small amounts of dexamethasone to bupivacaine incorporated in microcapsules prolonged local analgesia compared with microcapsules with plain bupivacaine after subcutaneous administration in humans...

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..These findings indicate a potential for major improvements in outcomes and reduction of costs if peri- and postoperative care can be adjusted to be in line with published evidence...

..The literature is inconclusive regarding the effect of local infiltration anaesthesia on the risk of recurrence after groin hernia repair...

..However, implications and results of this evidence for general practice are not known...

..Postoperative pain scores and analgesic requirements were similar. CONCLUSION: Combined ilioinguinal blockade and local infiltration anaesthesia is recommended for groin hernia repair to reduce intra-operative pain...

..These findings may serve as basis information for clinical studies of perioperative fluid management...

..To determine the incidence of groin pain 1 year after inguinal herniorrhaphy and to assess the influence of chronic groin pain on function...

..To minimise pain and the duration of convalescence, we recommend multi-modal analgesic treatment in combination with short, standardised instructions to resume work and normal activity...

..However, no study has evaluated the long-term effects of wound instillation of purified capsaicin on sensory functions...

..We investigated the feasibility and efficacy of a standardized, evidence-based anaesthesia/analgesic regime to identify residual problems in the early post-operative phase...

..Short-term success rate, satisfaction rates, and acceptability were all excellent. Follow up has been established to evaluate long-term success rates and recurrence...

..To compare convalescence after colonic surgery with a fast-track rehabilitation programme vs conventional care...

..At three months follow-up, there was reduced overall pain and no dysejaculation, and quantitative sensory testing showed reversal of sensory abnormalities, except for sensory loss, compared with preoperative values...

..A multi-disciplinary effort is necessary to achieve this goal, and the adjustment of postoperative surgical care is as important as the supply of anesthesiological techniques...

..To describe the the feasibility of and patients' satisfaction with day case repair of recurrent inguinal hernias under unmonitored local anaesthesia...

..IMPLICATIONS: Inguinal hernia repair can be safely performed under unmonitored local anesthesia with infrequent postoperative morbidity and acceptable satisfaction, but intraoperative pain may be a problem...

..The present placebo-controlled study was carried out to evaluate the analgesic effect of high-volume infiltration analgesia in bilateral total knee arthroplasty, along with a detailed description of the infiltration technique...

..The aim of this study was to describe in detail the consequences of recommending a short convalescence, including the risk of recurrence...

..Chronic pain after inguinal hernia repair is an adverse outcome that affects about 12 per cent of patients. Principles of treatment have not been defined. This review examines neurectomy and mesh or staple removal as possible treatments...

..We assessed orthostatic tolerance in relation to the postural cardiovascular responses before and shortly after open radical prostatectomy...

..The aim of this study was to evaluate the postoperative outcome after surgery for ovarian malignancy with conventional care compared to fast-track multimodal rehabilitation...

..Application of this knowledge from pathophysiologic responses to uncomplicated surgical injury should be explored in patients with severe surgical illness...

..Furthermore, no nationwide studies have been done. Our aim was to investigate outcome results of groin hernia surgery to improve quality of treatment...

..Recurrence after Lichtenstein repair is suspected to be caused by insufficient fixation and overlap at the pubic tubercle...

..CONCLUSION: Objectively measured postural stability and subjectively assessed balance return to normal within 60 minutes after inguinal herniorrhaphy under local infiltration anaesthesia, thereby permitting early discharge...

..However, readmissions may occur more frequently...

..The risk of recurrence of inguinal hernia within 5 years of repair is lower after mesh than sutured repair in men, but no large-scale studies have compared the risk of recurrence beyond 5 years...

..However, relatively few patients have been included in randomized trials, indicating a need for more studies to secure valid conclusions...

..In the treatment group, 1 patient had transitory purulent arthritis requiring antibiotics and arthroscopic synovectomy occurred...

..To investigate the feasibility of a 48-hour postoperative stay program after colonic resection...

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..6 per cent stated that it interfered with social activities. CONCLUSION: Chronic pain is common after primary inguinal hernia repair in young males, but there is no difference in the pain associated with open mesh and non-mesh repair...

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..These femoral recurrences occurred earlier than inguinal recurrences, suggesting that they were possibly femoral hernias overlooked at the primary operation...