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Query: UMLS:C0030794 (pelvic pain)
 4,056 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Presacral neurectomy is effective treatment for dysmenorrhea and midline pelvic pain. Conventional laparoscopic techniques describe retroperitoneal dissection to excise retroperitoneal nerve tissue. The argon beam coagulator (ABC) can be used laparoscopically to hemostatically ablate and thus separate the presacral tissues down to the periosteum without dissecting or excising tissue. In 32 patients undergoing laparoscopic presacral neurectomy, 17 were performed with conventional methods, and 15 patients underwent ABC neurotomy only, without dissection or excision. Postoperative pain reduction was the same in both groups (73% vs 75%), with average anesthesia time 64 min for ABC neurotomy vs 92 min with conventional techniques. One major vascular complication requiring immediate laparotomy occurred in the ABC group. When properly applied laparoscopically, the ABC is an effective tool to rapidly coagulate and separate the presacral nerves with minimal smoke, excellent visualization, and no retroperitoneal dissection.
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PMID:Laparoscopic presacral neurectomy vs neurotomy: use of the argon beam coagulator compared to conventional technique. 1017 91

Following reports that tubal smooth muscle spasm may contribute to pelvic pain following laparoscopic sterilisation, we studied the effect of buscopan (an anticholinergic agent used to relieve smooth muscle spasm) on 45 patients undergoing general anaesthesia for day-case laparoscopic sterilisation. Patients were randomly allocated to receive either buscopan 20 mg or saline placebo after induction of anaesthesia. There were no significant differences in pain scores or postoperative analgesic requirements between the two groups. We conclude that intravenous buscopan confers no benefit in day-case laparoscopic sterilisation.
Anaesthesia 1999 Apr
PMID:Intravenous buscopan for analgesia following laparoscopic sterilisation. 1045 43

Chronic pelvic pain is a complex disorder with multiple etiologies. Recently, the technique of microlaparoscopy under local anesthesia has been applied to chronic pelvic pain. The specialized technique of conscious pain mapping has been developed to aid in the diagnosis of these patients. This paper will review the history and usage of office and microlaparoscopy in general. It will then discuss specific applications for patients with acute or chronic pelvic pain.
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PMID:Microlaparoscopy under local anesthesia and conscious pain mapping for the diagnosis and management of pelvic pain. 1049 25

Objective: Laparoscopy, while routinely performed in the outpatient setting, is associated with considerable postoperative discomfort. Continuing pain experienced after surgery is due to post-traumatic functional changes in both the peripheral nervous system (hyperalgesia) and the central nervous system (hyperexcitability). Local anesthetic infiltrated at time of incision closure has limited effect because hypersensitivity and hyperexcitability have already developed. Preemptive analgesia refers to the blockage of afferent nerve fibers, before painful stimulus, which prevents or reduces subsequent pain even beyond the effect of the block. We tested the hypothesis that local anesthetic administered before skin incision, an example of preemptive analgesia, reduces postoperative pain for women undergoing laparoscopy, as compared to postincisional local anesthetic or placebo.Materials and Methods: Seventy-five patients undergoing laparoscopy for pelvic pain, infertility, or sterilization were randomized to one of three treatment groups. Two 10 mL syringes, labeled "Pre" and "Post," were prepared at time of laparoscopy and contents blinded to anesthesiology, surgeons, and the patient. For treatment group A (preincisional), the presyringe contained 10 mL of 0.5% bupivacaine (50 mg) and the postsyringe contained 10 mL of 0.9% saline. For treatment group B (postincisional) patients, the presyringe contained 10 mL of 0.9% saline and the postsyringe contained 10 mL of 0.5% bupivacaine. For treatment group C (control) patients, both syringes contained 10 mL of 0.9% saline. All patients underwent a standardized general anesthetic induction and maintenance. After the patient was properly positioned and draped, 5 mL of the presyringe was infiltrated into the umbilical incision site. The remaining 5 mL was infiltrated in a similar fashion at the suprapubic trocar placement site. After laparoscopy and immediately prior to closure of the incisions, the postsyringe was infiltrated into both incisions above and below the fascia in a diamond-shaped pattern.For postoperative pain, oral ibuprofen was given, as needed, with 30 mg intramuscular ketorolac tromethamine given if the patient was unable to tolerate oral pain medication. All patients were discharged with 800 mg ibuprofen tablets and asked to take as needed for pain relief. The modified McGill Present Pain Intensity scale was evaluated by nurse interview at 30 minutes, 2 hours, 4 hours, and 24 hours after incision closure. Statistical analysis was accomplished using chi(2) tests for proportional data and ANOVA for pain scores and other parametric data.Results: Fifty-seven patients completed the study protocol. Age, weight, height, race, indication, and operating time did not vary significantly between the three groups. Patients in treatment group A (n = 20) could tolerate a significantly longer time delay to their first analgesic medication. (A: 486.7 +/- 435.3 minutes; B: 229.4 +/- 330.4; C: 143.1 +/- 156.7, P <.001). Their 24-hour pain scores were also significantly lower than either treatment group B (n = 19) or C (n = 18) (A: 0.50 +/- 0.9; B: 1.61 +/- 1.3; C: 1.2 +/- 1.2, P <.02). Although statistical significance was not reached, patients in treatment group A required less total doses of analgesic than either treatment group B or C (A: 2.4 +/- 1.6 doses; B: 3.1 +/- 1.5; C: 3.1 +/- 1.2, P =.07).Conclusions: Preemptive local anesthesia in patients undergoing laparoscopy results in a longer time before analgesic is required and significantly lower pain 24 hours after surgery.
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PMID:A randomized blinded trial of preemptive local anesthesia in laparoscopy. 1083 76

Forty-two patients with chronic nonbacterial prostatitis (CNP) and twelve men without any urological complaints or history underwent intraprostatic tissue pressure measurement with a Stryker intracompartmental pressure monitor device. The pressures were measured under spinal anesthesia in connection with various surgical procedures. Tissue pressure was monitored at 10, 60 and 120 s after an injection of 1 ml saline. Significantly (P < 0.001) higher intraprostatic pressure values were registered at all the three time points in the patients with CNP compared to the controls. Our study shows that patients with CNP have elevated intraprostatic tissue pressures, probably reflecting increased tissue resistance and a poor tissue microcirculation status. It seems that this method can be used as a diagnostic tool to differentiate between various causes of chronic pelvic pain in the male. The aim is to develop further this method so that it is also suitable for outpatient use.
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PMID:Prostatic tissue pressure measurement as a possible diagnostic procedure in patients with chronic nonbacterial prostatitis/chronic pelvic pain syndrome. 1112 9

Adenoid cystic carcinoma is an uncommon histological type of the already rare carcinoma of Bartholin's gland with 51 cases described in the literature. We present a case of a 66-year-old woman who was admitted with severe pelvic pain. In an examination under anesthesia a 10x5 cm apparently fixed mass at the left vaginal wall originating from the area of Bartholin's gland was found. and biopsy indicated carcinoma. The patient underwent wide local excision. Although clinically inoperable, the tumor did not infiltrate the bony pelvis and no evidence of metastasis was found. Pathology examination revealed adenoid cystic carcinoma of Bartholin's gland. PCR did not detect human papillomavirus DNA in the specimen. The patient has been treated with adjuvant radiotherapy, and is alive with no evidence of disease after ten months.
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PMID:Adenoid cystic carcinoma of Bartholin's gland: a case report. 1149 68

Laparoscopy, is technique, indications, contraindications, and complications as well as the author's personal experience with it are described. It is a new procedure for diagnosis and treatment of intraabdominal and pelvic conditions. It is a safe and effective method of tubal ligation with shorter hospitalization time. The complete procedure for laparoscopy is discussed in the article. Most patients are able to leave the hospital the day of surgery, and the clips are removed in the office in 72 hours. Laparoscopy is used in sterilization and diagnostically in cases of infertility, pelvic pain, congenital anomalies, second look procedures, and removal of IUD. It should not be used in patients in whom anesthesia is contraindicated, or those with intestinal obstruction, peritonitis, and extensive abdominal scarring. The recovery rate is virtually 100% within 24 to 48 hours following laproscopy. Complications in the author's experience with laparoscopy include, perforation of inferior epigastric artery, postoperative PID, pneumo-omentum failure, pelvic vessel hematoma, and adenocarcinoma of the endometrium.
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PMID:Diagnostic laparoscopy -- a new diagnostic and therapeutic modality. 1225 2

The materials and methods of placing tubal rings are now well known and have changed little since the initial description. Most applicators can be loaded with 2 rings, simplifying the operating procedure. The choice of rings should be carefully made since differences in quality have been found. The ring should be placed in the middle of the isthmus 3 cm from the uterine cornu. After placement, the tubal loop will disappear more or less rapidley. The menstrual cycle does not appear to be modified. Numberous studies have confirmed the efficacy of tubal occlusion with Yoon silicone rings. The failure rate varied from 0-6/1000 in the initial series of 2421 cases, some of which had a follow-up of 5 years. Most failures occur in the 1st 2 years. Among advantages of sterilization with Yoon rings are its great simplicity for well trained practitioners and rarity of complications if contraindications are respected; the simplicity of the required materials; the method's efficacy and possibly reduced rate of ectopic pregnancy compared to tubal electrocoagulation; the high rates of client satisfaction; and its high reversibility if microsurgical techniques are used. The main operating problem is the impossibility of use in case of tubal pathology or large tubal diameter. Tubal tearing represents the principal complication, with hemorrhage occasionally occurring; these complications are often the result of rough handling, failure to respect local contraindications, or operator inexperience. Placement of a ring on each tubal extremity in case of a complete rupture resolves the complication readily, but bipolar coagulation, thermocoagulation, or application of clips may also be done. Resort to laparotomy does not appear necessary for a skilled laparoscopist. In Yoon's inital series the rates of tearing and bleeding were respectively 3.3 and .7%. Pelvic pain may occur during the placement of rings when general anesthesia is not used.
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PMID:[Mechanical laparoscopic sterilization through a tubal ring]. 1226 39

Around 28% of US women using contraception have accepted female sterilization. Female sterilization is a permanent contraceptive method. A surgeon usually uses a laparoscope to locate the fallopian tubes to either cut or obstruct them with clips, rings, or an electrical current under general or local anesthesia. Female sterilization is usually performed on an outpatient basis. The obstructed tubes keep sperm from fertilizing the egg. Female sterilization is very safe. The rare major complications tend to arise from general anesthesia use. The physician will discuss the risks and benefits of female sterilization before the surgery. The failure rate is 0.2-0.4%. Female sterilization might protect against ovarian cancer. Some sterilized women experience post-sterilization syndrome. Its symptoms include pelvic pain, change in sexual behavior, changes in mental health, changes in the menstrual cycle, increased blood loss, and increase in premenstrual symptoms. Most women do not suffer from this syndrome, however. It is not known whether sterilization is responsible for these changes or the changes are part of normal aging or gynecological problems. Terminating the previous contraceptive method (e.g., oral contraceptives) may contribute to the changes. Sterilization is for persons who do not want any more children. They should discuss sterilization first with their physician. They should ask the physician to explain the procedure and possible risks. Vasectomy should also be considered for couples who want no more children. Generally, due to less inhibition and more spontaneity without fear of pregnancy, sterilization improves sexual activity.
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PMID:Female sterilization. Patient update. 1228 83

Khandwala cites 30 cases of operative laparoscopy, a technique utilizing several surgical procedures for treating pathological conditions. All cases consisting of the following operative procedures were done under local anesthesia: 1) 20 cases (65%) of adhesiolysis. The procedure consisted of separating the adhesions and coagulating the blood vessels. In all cases the pelvis was cleared of adhesions; 2) 3 cases (10%) of aspiration of Ovarian cyst; 3) 2 cases (6.6%) fulguration of endometrial implants. Early diagnosis and treatment of endometriosis is thought to be one of the more useful achievements of laparoscopy; 4) 2 cases (6.6%) of IUD removal. X-rays are required for determining the exact location of the IUD. Plastic devices appear easier to remove than copper devices which produce adhesions and may require laparotomy; 5) 2 cases (6.6%) of partial salpingectomy; and 6) 1 case (3.3%) resection of uterosacrals due to chronic pelvic pain.
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PMID:Operative laparoscopy: a preliminary study. 1233 27


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