Numbing medicine for stitches: Lidocaine injection Uses, Side Effects & Warnings

01.12.197225.08.2021 by alexxlab

Содержание

Pain management for children needing laceration repair

Can Fam Physician. 2018 Dec; 64(12): 900–902.

Abstract

Question An 8-year-old child who lives in a small town has presented to my practice with a 3-inch laceration on the calf that has been assessed and needs repair with sutures. The family lives 4 hours from the nearest emergency department and I was planning to repair the wound in the office. What is the best way to manage pain in young patients needing sutures for laceration repair?

Answer Children are particularly susceptible to experiencing high levels of pain and anxiety during routine emergency procedures such as laceration repair. It is important to consider measures to reduce procedural pain. Using needle-free anesthesia, such as the lidocaine-adrenaline-tetracaine combination, might be effective to anesthetize the area. In instances where lidocaine-adrenaline-tetracaine is not sufficient, additional injected lidocaine or bupivacaine can be used. Buffering lidocaine with bicarbonate, warming the lidocaine ampule, and injecting the compound slowly at a perpendicular angle to the skin will reduce pain associated with the injection.

Lacerations are common presentations to physicians’ offices, and approximately 8% of all pediatric and adult presentations to emergency departments (EDs) are owing to lacerations.^¹ Children in urban centres presenting to their family physicians with lacerations will often be referred to the local ED for suturing. However, nearly 20% of Canada’s population lives in rural areas with fewer than 1000 inhabitants and limited access to an ED,^²,³ and in these areas family physicians commonly respond to children’s needs in their offices. Pain and anxiety play a considerable role in shaping the pediatric experience,^⁴ and general practitioners can reduce pain during laceration repair in the office by using a mix of topical and injectable anesthesia. ^⁵

Infiltrative anesthesia: lidocaine and bupivacaine

Infiltrative or injected anesthesia, such as 1% or 2% lidocaine, has been a commonly used method for pain management during laceration repair.^⁶ Lidocaine relieves pain by blocking the sodium channels in the local nerve fibres and has proven to be effective, particularly for deeper lacerations.^⁷ Adding adrenaline can be useful owing to its vasoconstrictive effect on the surrounding blood vessels, thus reducing potential toxicity of systemic distribution of anesthetic and reducing excessive bleeding at the site of injury.^⁸ For many years it has been recommended to avoid lidocaine with a vasoconstrictor on the digits, penis, nose, and ears owing to the tenuous end-artery blood supply to these areas^⁶; however, more recently adrenaline has been shown to be safe to use in digits as long as surrounding vasculature is intact. ^⁹

Other compounds for anesthesia are also available, including bupivacaine, mepivacaine, procaine, and tetracaine.^⁶ Bupivacaine has a longer half-life and longer duration of anesthesia.^¹⁰ In a double-blind randomized controlled trial of 104 patients, pain was rated significantly higher 2 hours after wound repair in the lidocaine-treated group compared with the bupivacaine-treated group (P < .001).^¹¹

Infiltrative anesthesia is contraindicated in patients with an allergy to the product or local infection in the area of injection. Allergic reaction to lidocaine is usually a result of the methylparaben preservative used for storage, and a preservative-free lidocaine can be used.^⁶ However, given the reduced shelf-life of preservative-free lidocaine it might not be practical to store it in a remote family practice. Allergy to procaine or tetracaine does not preclude patients from using lidocaine and vice versa, as they have different chemical structures. ^⁶

Administering local anesthesia: pain-reduction techniques

Reducing pain from injectable anesthetics^¹² can be done by injecting the compound slowly^¹³ and directing the needle in a perpendicular angle to the skin, which has been shown to reduce sensory nerve irritation.^¹⁴ Physicians can also attempt to move the needle through areas of the skin that have already been anesthetized,^¹⁴ or they can begin injection at the wound edges rather than through intact skin.^¹⁵

Bicarbonate buffering is a useful technique for reducing pain during lidocaine injection because much of the pain associated with lidocaine injection is due to infiltration of the acidic compound.^¹⁶ The addition of bicarbonate brings lidocaine to a neutral pH level, similar to that of body tissue.^¹⁶ While buffering lidocaine reduces its shelf-life to 1 week,^¹⁷ it has been shown to reduce mean pain scores from 8. 2 (out of 10) for plain lidocaine to 4.7 (out of 10) for buffered lidocaine (P < .05).^¹⁸

Warming the lidocaine ampule before use was also shown to reduce pain in a meta-analysis of 18 studies including 831 adult patients.^¹⁹ Pooled analysis revealed a reduction of 11 mm in pain on a 0- to 100-mm pain scale (95% CI −7 to −14 mm). A subanalysis of 8 studies revealed warmed and buffered lidocaine was as effective as warm or buffered solutions for pain reduction.^¹⁹ Warming and buffering together had an additive effect on pain reduction among healthy volunteers.^²⁰ These findings were not supported by a recent study in ED patients with wounds in which warmed, buffered, or warmed and buffered solutions did not significantly differ in reducing pain, suggesting no synergistic effect in a trauma setting.^²¹

Needle-free local anesthesia

Topical anesthetics have been shown to be highly effective in reducing pain associated with suturing. ^⁴ Topical anesthetics are of special benefit in children with contraindication to injectable anesthesia, difficulty tolerating injections, and needle phobia.^¹²

A tetracaine-adrenaline-cocaine combination was the first topical anesthetic gel produced in 1980,^²² but it fell out of favour after a number of cocaine toxicity–related fatalities were reported.^²³–²⁵ Furthermore, cocaine-free products offer the same level of pain relief.^¹² In 1996, the use of topical anesthesia (cocaine-adrenaline mix) showed no difference in pain relief compared with plain 1% lidocaine in children.^²⁶ More recently, a randomized controlled trial of 110 patients found topical lidocaine hydrochloride putty to be equally effective as injected lidocaine with a mean difference in pain of 0 (95% CI −1 to 0).^²⁷

Lidocaine-adrenaline-tetracaine gel.

The lidocaine-adrenaline-tetracaine (LAT) combination is a topical gel containing 4% lidocaine, 1:2000 adrenaline, and 0.5% tetracaine.^²⁸ While lidocaine provides effective pain relief and “numbs” the effective area through sodium channel blockade, adrenaline works to induce vasoconstriction and leave the affected area dry, which can be beneficial if a tissue adhesive solution is being used instead of sutures.^⁵ Lidocaine-adrenaline-tetracaine has been shown to improve patient outcomes for a number of painful pediatric procedures (including intravenous cannulation^²⁹ and lumbar puncture^³⁰) and reduce the need for injected anesthesia.^³¹ The use of LAT gel for pain minimization has become standard practice for large-scale EDs^⁴ and is far less expensive than its predecessor, the tetracaine-adrenaline-cocaine combination.^³² In a double-blind placebo-controlled trial,^³¹ LAT was shown to statistically significantly reduce pain associated with lidocaine injection before suturing. It was also shown to be effective when used alone for laceration repair (ie, without adjunctive infiltrative anesthetic). In a study of 60 adult patients, 30 were treated without LAT and all required additional infiltrative anesthetic, whereas less than half of the 30 patients who received LAT before treatment required additional injected lidocaine.^³³

The use of LAT has been mainly introduced into large-scale EDs and relies heavily on nurses’ ability to identify wounds that might need some form of primary closure and apply LAT early on at triage, such that the anesthetic has time to take effect while the patient waits to see the doctor.^³¹ Sherman and colleagues identified a low uptake of topical anesthesia use in a large tertiary pediatric ED where only 57% of patients received LAT gel before painful procedures.^⁴ Furthermore, it has been postulated that LAT might have reduced usefulness in a primary care setting where the length of time it takes to numb the surrounding area (up to 1 hour) is longer than the length of time patients would wait to see their doctors. ^³¹ Despite potential drawbacks, LAT use should be strongly considered in laceration repair procedures in the family practice setting.^{⁴,³¹,³³}

Amethocaine and tetracaine gels.

The 4% amethocaine and the 4% tetracaine gels are frequently used for painful pediatric procedures like intravenous cannulation.^³⁴ However, neither are approved for use on broken skin and there is a relative lack of research regarding their effectiveness during laceration repair.

Lidocaine-prilocaine combination.

The 2.5% lidocaine and 2.5% prilocaine combination—in gel, cream, or patch form—is currently not approved for use on mucous membranes or broken skin, reducing its usefulness in laceration repair with sutures. Past research has shown the lidocaine-prilocaine combination to be effective on broken skin and mucous membranes^³¹,³² and it has been used successfully off label for laceration repair in children^³⁵; however, it should not be a first-line topical anesthetic, particularly given the availability of LAT. In a head-to-head comparison of LAT versus the lidocaineprilocaine combination used on open wounds in patients aged 1 to 59 (median age of 8.5 years) there were no clinically significant differences in pain and acceptability found between treatments. Also, LAT is less expensive than the lidocaine-prilocaine combination is.^³²

Conclusion

When repairing lacerations in children it is important to use all available techniques to manage pain. It is important for physicians to focus on injection-associated pain of local anesthetics. Pain management should be top priority in managing children with minor trauma. In instances where infiltrative anesthetic is needed, 1% buffered or warmed lidocaine can be used. Evidence-based pain-reduction techniques, such as slow infiltration into wound edges, should also be used.

Notes

Child Health Update is produced by the Pediatric Research in Emergency Therapeutics (PRETx) program (www. pretx.org) at the BC Children’s Hospital in Vancouver, BC. Ms Lambert is a member and Dr Goldman is Director of the PRETx program. The mission of the PRETx program is to promote child health through evidence-based research in therapeutics in pediatric emergency medicine.

Do you have questions about the effects of drugs, chemicals, radiation, or infections in children? We invite you to submit them to the PRETx program by fax at 604 875-2414; they will be addressed in future Child Health Updates. Published Child Health Updates are available on the Canadian Family Physician website (www.cfp.ca).

Footnotes

Competing interests

None declared

This article is eligible for Mainpro+ certified Self-Learning credits. To earn credits, go to www.cfp.ca and click on the Mainpro+ link.

La traduction en français de cet article se trouve à www. cfp.ca dans la table des matières du numéro de décembre 2018 à la page e526.

References

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Badeau A, Lahham S, Osborn M. Management of complex facial lacerations in the emergency department. Clin Pract Cases Emerg Med. 2017;1(3):162–5. [PMC free article] [PubMed] [Google Scholar]9. Lalonde D, Bell M, Benoit P, Sparkes G, Denkler K, Chang P. A multicenter prospective study of 3,110 consecutive cases of elective epinephrine use in the fingers and hand: the Dalhousie Project clinical phase. J Hand Surg Am. 2005;30(5):1061–7. [PubMed] [Google Scholar]10. Collins JB, Song J, Mahabir RC. Onset and duration of intradermal mixtures of bupivacaine and lidocaine with epinephrine. Can J Plast Surg. 2013;21(1):51–3. [PMC free article] [PubMed] [Google Scholar]11. Spivey WH, McNamara RM, MacKenzie RS, Bhat S, Burdick WP. A clinical comparison of lidocaine and bupivacaine. Ann Emerg Med. 1987;16(7):752–7. [PubMed] [Google Scholar]12. Milliron M, Lembersky O. Update: topical anesthetics for pain control during repair of dermal laceration. Ann Emerg Med. 2018;72(2):e1–2. Epub 2017 Dec 6. 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Pain management for children needing laceration repair

Can Fam Physician. 2018 Dec; 64(12): 900–902.

Abstract

Infiltrative anesthesia: lidocaine and bupivacaine

Infiltrative or injected anesthesia, such as 1% or 2% lidocaine, has been a commonly used method for pain management during laceration repair.^⁶ Lidocaine relieves pain by blocking the sodium channels in the local nerve fibres and has proven to be effective, particularly for deeper lacerations.^⁷ Adding adrenaline can be useful owing to its vasoconstrictive effect on the surrounding blood vessels, thus reducing potential toxicity of systemic distribution of anesthetic and reducing excessive bleeding at the site of injury. ^⁸ For many years it has been recommended to avoid lidocaine with a vasoconstrictor on the digits, penis, nose, and ears owing to the tenuous end-artery blood supply to these areas^⁶; however, more recently adrenaline has been shown to be safe to use in digits as long as surrounding vasculature is intact.^⁹

Infiltrative anesthesia is contraindicated in patients with an allergy to the product or local infection in the area of injection. Allergic reaction to lidocaine is usually a result of the methylparaben preservative used for storage, and a preservative-free lidocaine can be used. ^⁶ However, given the reduced shelf-life of preservative-free lidocaine it might not be practical to store it in a remote family practice. Allergy to procaine or tetracaine does not preclude patients from using lidocaine and vice versa, as they have different chemical structures.^⁶

Administering local anesthesia: pain-reduction techniques

Bicarbonate buffering is a useful technique for reducing pain during lidocaine injection because much of the pain associated with lidocaine injection is due to infiltration of the acidic compound. ^¹⁶ The addition of bicarbonate brings lidocaine to a neutral pH level, similar to that of body tissue.^¹⁶ While buffering lidocaine reduces its shelf-life to 1 week,^¹⁷ it has been shown to reduce mean pain scores from 8.2 (out of 10) for plain lidocaine to 4.7 (out of 10) for buffered lidocaine (P < .05).^¹⁸

Needle-free local anesthesia

Topical anesthetics have been shown to be highly effective in reducing pain associated with suturing.^⁴ Topical anesthetics are of special benefit in children with contraindication to injectable anesthesia, difficulty tolerating injections, and needle phobia.^¹²

Lidocaine-adrenaline-tetracaine gel.

The lidocaine-adrenaline-tetracaine (LAT) combination is a topical gel containing 4% lidocaine, 1:2000 adrenaline, and 0.5% tetracaine.^²⁸ While lidocaine provides effective pain relief and “numbs” the effective area through sodium channel blockade, adrenaline works to induce vasoconstriction and leave the affected area dry, which can be beneficial if a tissue adhesive solution is being used instead of sutures.^⁵ Lidocaine-adrenaline-tetracaine has been shown to improve patient outcomes for a number of painful pediatric procedures (including intravenous cannulation^²⁹ and lumbar puncture^³⁰) and reduce the need for injected anesthesia.^³¹ The use of LAT gel for pain minimization has become standard practice for large-scale EDs^⁴ and is far less expensive than its predecessor, the tetracaine-adrenaline-cocaine combination. ^³² In a double-blind placebo-controlled trial,^³¹ LAT was shown to statistically significantly reduce pain associated with lidocaine injection before suturing. It was also shown to be effective when used alone for laceration repair (ie, without adjunctive infiltrative anesthetic). In a study of 60 adult patients, 30 were treated without LAT and all required additional infiltrative anesthetic, whereas less than half of the 30 patients who received LAT before treatment required additional injected lidocaine.^³³

The use of LAT has been mainly introduced into large-scale EDs and relies heavily on nurses’ ability to identify wounds that might need some form of primary closure and apply LAT early on at triage, such that the anesthetic has time to take effect while the patient waits to see the doctor.^³¹ Sherman and colleagues identified a low uptake of topical anesthesia use in a large tertiary pediatric ED where only 57% of patients received LAT gel before painful procedures. ^⁴ Furthermore, it has been postulated that LAT might have reduced usefulness in a primary care setting where the length of time it takes to numb the surrounding area (up to 1 hour) is longer than the length of time patients would wait to see their doctors.^³¹ Despite potential drawbacks, LAT use should be strongly considered in laceration repair procedures in the family practice setting.^{⁴,³¹,³³}

Amethocaine and tetracaine gels.

Lidocaine-prilocaine combination.

Conclusion

Notes

Child Health Update is produced by the Pediatric Research in Emergency Therapeutics (PRETx) program (www.pretx.org) at the BC Children’s Hospital in Vancouver, BC. Ms Lambert is a member and Dr Goldman is Director of the PRETx program. The mission of the PRETx program is to promote child health through evidence-based research in therapeutics in pediatric emergency medicine.

Footnotes

Competing interests

None declared

This article is eligible for Mainpro+ certified Self-Learning credits. To earn credits, go to www.cfp.ca and click on the Mainpro+ link.

La traduction en français de cet article se trouve à www.cfp.ca dans la table des matières du numéro de décembre 2018 à la page e526.

References

Stitches (Sutures): Purpose, Procedure, Recovery

Most minor cuts and scrapes heal on their own, with little more intervention needed than mild soap and water to keep them clean. But more serious cuts or incisions from surgical procedures may require stitches, or sutures, to hold tissues together while they heal. The goal is to piece together the edges so that skin and other tissues can fuse back together. Then the stitches are removed.

Although it’s natural to feel a little anxious if you’re getting stitches, especially if you’ve just experienced trauma, the procedure is generally painless. And stitches will help cuts heal with minimal scarring or risk for infection.

Signs a Cut May Need Stitches

It’s not always easy to tell if a cut requires stitches. Ultimately, it’s up to your health care provider to determine if stitches are needed. You should seek medical care for any cut that:

Is deep, jagged, or gaping
Is on the face or another part of the body where scarring may be an issue
Bleeds profusely without stopping after 20 minutes of direct pressure
Feels numb
Is in a hand or limb that doesn’t function properly after being cut

If any of these criteria apply to your injury, see a doctor as soon as you can. In the meantime, apply direct pressure to help control bleeding. It might also help to raise the injured area above the level of your heart, if possible.

There are certain instances in which stitches may not be advised, such as puncture wounds, though you may still need to see a doctor, especially if you have not had a tetanus shot in more than five years.

The Procedure

Once a health care provider has assessed your injury and determined that you need stitches, the first steps they will take in treating the wound are to clean and numb the area, though not necessarily in that order. Although cleaning a wound is not very painful in most cases, the doctor may first administer a local anesthetic, similar to what your dentist might use, to maximize your comfort. If your injury seems particularly contaminated, however, cleansing it — usually with running tap water and a mild soap — may be a higher priority.

Once the area is numb, the doctor will take a closer look to make sure there’s no dirt, debris, or other foreign objects inside the cut before sewing it together. An X-ray may also be ordered to help look for remaining debris. If you cut yourself on a piece of glass or sharp metal, for instance, it’s crucial to ensure that there are no remaining shards inside the cut.

The doctor may remove any dead tissues to help the healing process. They will then pull the edges of the cut together and, for each stitch, loop thread through either side of the cut and tie a knot to hold the wound closed.

Doctors can use different types of surgical thread made from materials such as silk or nylon, which may be in single filaments or braided. There’s even surgical thread that is designed to dissolve over time so that the stitches don’t need to be removed. These are used most frequently in deep cuts.

Caring for Stitches

The doctor or nurse will give you instructions for caring for your stitches as your cut heals. These may include specific steps for cleaning and dressing the wound. You may be advised to keep the wound and bandages dry.

Your doctor may also recommend an antibiotic ointment to help prevent infection and make you aware of signs that may indicate infection. Keep an eye out for such signs, including a fever higher than 100 degrees or red streaks on the skin near the wound. And if any of your stitches pop or break, or you have any other concerns, be sure to contact your doctor.

Removal of Stitches

Stitches typically need to remain in place for several days to a couple of weeks, depending on the severity of the cut and location. Your doctor will tell you when to come back to have them taken out. Removing stitches is a much faster process than putting them in. The doctor simply clips each thread near the knot and pulls them out. You may feel a slight tugging sensation, but the removal of stitches shouldn’t hurt at all. You won’t even need an anesthetic.

Although removing stitches is not a difficult process, you shouldn’t try to remove them yourself. It’s important for your doctor to check to see that the wound is healing properly and to make sure that it’s OK for the stitches to come out. The doctor may also have special instructions for you after the stitches are removed, which may help minimize scarring.

Other Options

Stitches aren’t the only option doctors have to close cuts and incisions. Cuts sometimes can be held together with butterfly tape or adhesive strips, which you may be able to do yourself at home for more minor cuts. There are even special staples or tissue glue, but those tend to work best with clean, straight incisions, such as in surgical procedures.

There are different criteria and care instructions for each type of closure. Your health care provider can help decide which is best for you and tell you how to care for your injury as it heals.

ProcGuide: Suturing

Go to the Ethicon suturing manual and this knot tying manual for more references.

ANESTHESIA

Mechanism: Local anesthetics infiltrate tissues and diffuse across neural sheaths and membranes. They interfere with depolarization.

Onset of action : If anesthetic is delivered at the interface of the superficial fascia and dermis, blockade is very rapid. Wound cleansing and suturing can begin almost immediately. When blocking larger nerve trunks such as digital nerves, onset of action is much slower (4-10 minutes for lidocaine).

Duration: Lidocaine (Xylocaine) is 30-120 minutes. Lidocaine with epinephrine is 60-240 minutes. Mepivacaine (Carbocaine) is 90-180 minutes.

Addition of epinephrine: Decreases the amount of bleeding in a wound. Most serious side effect is tissue ischemia. DO NOT inject into fingers, toes, tip of the nose, pinna of the ear or penis. In susceptible patients, it can cause palpitations and tremors. Known coronary artery disease and hypertension are relative contraindications to the use of epinephrine. It is advisable to aspirate before injection to avoid direct intravascular bolusing.

Toxicity of local anesthetics: Most common is vasovagal syncope secondary to pain and anxiety. Less common are cardiovascular reactions and excitatory central nervous system effects. Cardiovascular reactions include hypotension and bradycardia and are caused by a myocardial inhibitory effect of the anesthetic. Excitatory central nervous system effects can culminate in seizure activity. The less common reactions are usually caused by inadvertent injection of a solution directly into a blood vessel. Management is supportive (airway control, IV access, and administration of epinephrine, diphenhydramine and steroids as needed).

Alternatives for the allergic patient: No anesthetic, ice over the wound, preservative-free anesthetic, use diphenhydramine (Benadryl) – lasts approximately 30 minutes, a 50 mg (1 mL) vial is diluted in a syringe with 4 mL normal saline to produce a 1% solution. Infiltration is carried out in the usual manner. Diphenhydramine is more painful to inject than lidocaine and the pain is not reduced with buffering.

Topical Anesthetic: Onset 5-15 minutes. Duration 20-30 minutes.

Buffer: Use bicarbonate. 1 mL of bicarbonate to 9 mL 1% Lidocaine; buffering of 2% lidocaine may cause precipitates – shelf life 7 days. Mepivacaine (Carbocaine) 0.5-1 mL bicarbonate per 9 mL mepivicaine – shelf-life unknown after 24 hours. Bupivacaine (Marcaine) – 0.1 mL of bicarbonate per 20 mL bupivacaine – shelf-life unknown after 24 hours.

Needle choices: A 25-gauge, 1-inch needle can be used for most local infiltration procedures, as well as facial and digital blocks. 27- or 30-gauge needles – small gauge reduces the pain of needle injection and slows the rate of anesthetic infusion. Rapid injection and tissue expansion is more painful than slow injection.

TECHNIQUE FOR WOUND ANESTHESIA

Most minor lacerations and wounds can be managed by administering a local anesthetic directly into or around (parallel to) the wound area.

Direct Wound Infiltration: Direct infiltration through the wound is indicated for most minimally contaminated lacerations in anatomically uncomplicated areas. Needlestick pain is less because intact skin is not pierced. Use 25-, 27- or 30- gauge needles with length of _ to 1_ inches. Insert the needle through the open wound into the superficial fascia (subcutaneous fat) parallel and just deep to the dermis. Inject a small bolus of anesthetic solution. Remove the needle and inject another bolus at an adjacent site, but just inside the margin of anesthesia of the previous injection. This ensures greater patient comfort. Repeat this process until all edges and corners of the wound are anesthetized. A simple laceration 3-4 cm in length requires 3 to 5 mL of an anesthetic solution.

Parallel Margin Infiltration: Alternative to direct wound infiltration and has the advantage of requiring fewer needle sticks. It is preferred in wounds that are grossly contaminated so that the needle does not inadvertently carry debris or bacteria into uncontaminated tissues. The same plane for direct wound infiltration is used, but approached through intact skin. Parallel infiltration requires at least a 25-gauge, 1 _ to 2 inch needle. The needle is inserted through the skin at one end of the laceration. The needle is advanced to the hub parallel to the dermis-superficial fascia plane. Aspiration is followed by slow injection of a “track” of anesthetic as the needle is withdrawn down the tissue plane to the insertion site. The needle tip is then reinserted at the distal end of the first track where the skin is beginning to become anesthetized. Reinsertion and injection is repeated on all sides of the wound until complete infiltration has been achieved.

WOUND CLEANSING

Generally, wounds should be closed within 6-8 hours. Less if contaminated.

Appropriate protective gloves and eyewear should be worn at all times.

Cleansing and irrigation are the foundation of good wound care. It is essential that all contaminants and devitalized tissue are removed before wound closure. If not, the risk of infection and a cosmetically poor scar are greatly increased. Hair removal is not necessary prior to wound repair however removing scalp hair may make repair easier as suture material can become entangled. Do not shave or clip eyebrows. Hair re-growth of the brow is unpredictable in many patients. Eyebrow hair can be readily cleansed, and the brow borders provide excellent landmarks for laceration alignment during wound closure.

Wound Cleansing Agents:

Povidone-Iodine Solution (Betadine) – (Do not use the surgical scrub which is toxic to wound tissues.) Strongly bactericidal against gram-positive and gram-negative bacteria. Minimally toxic to wound tissues. Can be used for wound-periphery cleanser.

Poloxamer 188 – No antibacterial activity. No known tissue toxicity. Particularly useful on the face.

Irrigation:

Following periphery cleansing, the wound is irrigated with a syringe and splash shield using normal saline.

Cleansing is complete and a wound is ready to close when it looks clean to the eye. There should be no visible contaminants, and the tissue should appear pink and viable. Usually there is slight fresh bleeding. A sterile sponge can be laid over the wound until the operator is ready to proceed with repair.

Cleansing setup and procedure:

Position patient

Anesthesia

Gather supplies and set-up for cleansing and irrigation

Clean Wound

Irrigate

Debride/Remove devitalized tissue (may want surgical assistance)

INSTRUMENTS AND SUTURE MATERIAL

Instruments:

Needle holder, forceps and suture scissors will likely be needed for all repairs.

Recommended forceps – 4_ -inch Adson’s with small teeth. Teeth decrease the need to apply excessive force to grasp and secure tissue. Forceps without teeth are discouraged because the flat surface of their jaws tends to crush tissues more easily.

Suture Materials:

Nonabsorbable sutures are most commonly used for percutaneous or skin closure.

Absorbable sutures are placed deep for closure of dead space in large wounds or to reduce closure tension.

Nonabsorbable Material:

Silk — has a braided structure. Easy to handle but has increased potential for infection.

Nylon (Ethilon, Dermalon) — has a monofilament structure. Commonly used in skin closure but high degree of memory; requires several throws for secure closure.

Polypropylene (Prolene) — has a monofilament structure. High degree of memory, low tissue adhesion; good for subcuticular pull-out technique.

Dacron (Mersilene) — has a braided structure. Easy to handle, good knot security; like silk but less risk to tissue for inflammation and infection.

Polybutester (Novafil) — has a monofilament structure. Excellent handling, strength and security. Expands and contracts with changes in tissue edema.

Absorbable Material:

Polyglycolic acid — PGA (Dexon) has a braided structure. Tissue half-life is 25 days. Used for subcutaneous closure; coated version easier to use but requires more knots (Dexon-Plus) — 4 to 6 versus 3 to 4.

Polyglactin 910 (Vicryl) — has a braided structure. Tissue half-life is 28 days. Comes dyed and undyed; do not used dyed on face; irradiated polyglactin excellent for mucosal closures.

Polyglyconate (Maxon) — has a monofilament structure. Tissue half-life is 28-36 days. For subcutaneous closure; less reactive and stronger than PGA and polyglactin

Polydioxanone (PDS) — has a monofilament structure. Tissue half-life is 36-53 days. For subcutaneous closures that need high degree of security; stiffer and more difficult to handle than PGA or Maxon.

Suggested Guidelines for Suture Material and Size for Body Region:

Note: Percutaneous = skin; deep = dermal layer

Nonabsorbable Monofilament — Nylon (Ethilon, Dermalon), Polypropylene (Prolene), and Polybutester (Novafil)

Absorbable materials for dermal and fascial closures — Polyglycolic acid (Dexon, Dexon Plus), Polyglactin 910 (Vicryl), Polydioxanone (PDS — monofilament absorbable), Polyglyconate (Maxon — monofilament absorbable)

Absorbable materials for mucosal and scrotal closure — Chromic gut, Polyglactin 910 (Vicryl)

Scalp Percutaneous (skin): 5-0/4-0 Monofilament
- Deep (dermal): 4-0 Absorbable

Ear Percutaneous: 6-0 Monofilament

Eyelid Percutaneous: 7-0/6-0 Monofilament

Eyebrow Percutaneous: 6-0/5-0 Monofilament

Nose Percutaneous: 6-0 Monofilament

Lip Percutaneous: 6-0 Monofilament

Oral Mucosa Deep: 5-0 Absorbable

Other Parts Of Face & Forehead Percutaneous: 6-0 Monofilament

Trunk Percutaneous: 5-0/4-0 Monofilament

Extremities Percutaneous: 5-0/4-0 Monofilament

Hand Percutaneous: 5-0 Monofilament

Foot/Sole Percutaneous: 4-0/3-0 Monofilament

ALTERNATIVE CLOSURES

Taping can be used for superficial wounds under little tension. Taping is also appropriate in the elderly or steroid-dependent patient who has thin, fragile skin. Taping can also be used for support after sutures are removed. Tape does not work well on irregular wounds, those that can not be made free of blood or secretions, intertriginous areas, scalp and joint surfaces. Tapes are maintained in place at least as long as sutures would be for the anatomic area in question. Taped wounds should not be washed or moistened because premature tape removal can lead to wound dehiscence. Note: Tapes should never be wrapped around a digit in a circumferential manner because they are not expandable and can act as a constricting band.

Wound Adhesives feature short wound closure time and require no anesthesia. Wounds are at greater risk of breaking open during the first 7 days compared to sutures but after that, there is no difference. Indications for use are linear and curvilinear lacerations under little tension (< 0.5 cm wide) where no deep sutures are required. Lacerations should have sharp wound edges before or after debridement. Lacerations should be 5 cm or less. Adhesives are not effective for lacerations over joints, with excessive bleeding, or with high static tension as evidenced by edge gaping. Caution is used for lacerations near the eye. Hair-bearing areas are not a contraindication for adhesive closure. Patients should be instructed to keep the wound clean and dry for 24 hours. Wound dressings can be applied on areas other than the face. Should a wound dehisce, the patient should be instructed to return so that delayed primary closure can be carried out. No follow-up is necessary for glue removal because it will peel off on its own or come off with natural sloughing of keratinized epidermis.

RECOMMENDED INTERVALS FOR REMOVAL OF SKIN SUTURES:

Scalp 6-8 days

Face 4-5 days

Ear 4-5 days

Chest/Abdomen 8-10 days

Back 12-14 days

Arm/Leg* 8-10 days

Hand* 8-10 days

Fingertip 10-12 days

Foot 12-14 days

*Add 2 to 3 days for joint extensor surfaces.

WOUND AFTERCARE

Pain should subside significantly after 24-48 hours. Patient should see physician immediately if pain increases or recurs. Concern would be wound infection.

Elevation is particularly important in extremity wounds.

Sutured wounds of the scalp and face can be left open if kept clean. Most wounds can be gently cleansed 12-24 hours after wound repair. Patients can bath in the same interval on a daily basis as long as the wound is not immersed or soaked in water. Application of an antibiotic ointment or reapplication of a dressing is recommended after each washing.

Signs of wound infection patients should watch for and have evaluated immediately by a medical professional should they occur: excessive discomfort, continuous drainage (especially purulent), wound redness that extends more than 5 mm beyond the wound margins accompanied by swelling, induration or tenderness, lymphatic streaks, lymph node enlargement and fever.

Pain Control After Surgery: Symptoms, Treatment

Why is pain control after surgery so important?

Pain control following surgery is a priority for both you and your doctors. While you should expect to have some pain after your surgery, your doctor will make every effort to safely reduce it.

In addition to keeping you comfortable, pain control can help speed your recovery and may reduce your risk of developing certain complications after surgery, such as pneumonia and blood clots. If your pain is well controlled, you will be better able to complete important tasks, such as walking and deep breathing exercises.

The following information should help you understand your options for pain management. It will describe how you can help your doctors and nurses control your pain and empower you to take an active role in making choices about pain treatment.

Be sure to tell your doctor if you are taking pain medication at home on a regular basis and if you are allergic to or cannot tolerate certain pain medications.

What kinds of pain will I feel after surgery?

You may be surprised where you feel pain after surgery. The site of surgery is often not the only area of discomfort. You may or may not feel the following:

Muscle pain: You may feel muscle pain in the neck, shoulders, back or chest from lying on the operating table.
Throat pain: Your throat may feel sore or scratchy.
Movement pain: Sitting up, walking, and coughing are all important activities after surgery, but they may cause increased pain at or around the incision site.

What can I do to help keep my pain under control?

Important! Your doctors and nurses want and need to know about pain that is not well controlled. If you are having pain, please tell someone! Don’t worry about being a “bother.”

You can help the doctors and nurses “measure” your pain. While you are recovering, your doctors and nurses will frequently ask you to rate your pain on a scale of 0 to 10, with “0” being “no pain” and “10” being “the worst pain you can imagine. ” Reporting your pain as a number helps the doctors and nurses know how well your treatment is working and whether to make any changes. Keep in mind that your comfort level (your ability to breathe deeply or cough) is more important than absolute numbers (your pain score).

Who is going to help manage my pain?

You and your surgeon will decide what type of pain control would be most acceptable for you after surgery. Your surgeon may choose to consult a pain specialist help manage your pain following surgery. Pain specialists are specifically trained in the types of pain control options that follow.

You are the one who ultimately decides which pain control option is most acceptable. The manager of your post-surgical pain will review your medical and surgical history and check the results from your laboratory tests and physical exam. They can then advise you about which pain management option may be best suited to safely minimize your discomfort.

After surgery, you will be assessed frequently to ensure that you are comfortable and safe. When necessary, adjustments or changes to your pain management regimen will be made.

What are the types of pain-control treatments?

You may receive more than one type of pain treatment, depending on your needs and the type of surgery you are having. All of these treatments are relatively safe, but like any therapy, they are not completely free of risk. Dangerous side effects are rare. Nausea, vomiting, itching, and drowsiness can occur. These side effects can be troubling but are usually easily treated in most cases.

Intravenous patient-controlled analgesia (PCA)

Patient-controlled analgesia (PCA) is a computerized pump that safely permits you to push a button and deliver small amounts of pain medicine into your intravenous (IV) line, usually in your arm. No needles are injected into your muscle. PCA provides stable pain relief in most situations. Many patients like the sense of control they have over their pain management.

The PCA pump is programmed to give a certain amount of medication when you press the button. It will only allow you to have so much medication, no matter how often you press the button, so there is little worry that you will give yourself too much.

Never allow family members or friends to push your PCA pump button for you. This removes the patient control aspect of treatment, which is a major safety feature. You need to be awake enough to know that you need pain medication.

Patient-controlled epidural analgesia

Many people are familiar with epidural anesthesia because it is frequently used to control pain during childbirth. Patient-controlled epidural analgesia uses a PCA pump to deliver pain-control medicine into an epidural catheter (a very thin plastic tube) that is placed into your back.

Placing the epidural catheter (to which the PCA pump is attached) usually causes no more discomfort than having an IV started. A sedating medication, given through your IV, will help you relax. The skin of your back will be cleaned with a sterile solution and numbed with a local anesthetic. Next, a thin needle will be carefully inserted into an area called the “epidural space.” A thin catheter will be inserted through this needle into the epidural space, and the needle will then be removed. During and after your surgery, pain medications will be infused through this epidural catheter with the goal of providing you with excellent pain control when you awaken. If additional pain medication is required, you can press the PCA button.

Epidural analgesia is usually more effective in relieving pain than intravenous medication. Patients who receive epidural analgesia typically have less pain when they take deep breaths, cough, and walk, and they may recover more quickly. For patients with medical problems such as heart or lung disease, epidural analgesia may reduce the risk of serious complications such as heart attack and pneumonia.

Epidural analgesia is safe, but like any procedure or therapy, it’s not risk free. Sometimes the epidural doesn’t adequately control pain. In this case you’ll be given alternative treatments or be offered replacement of the epidural. Nausea, vomiting, itching and drowsiness can occur. Occasionally you may experience numbness and weakness of the legs which disappears after the medication is reduced or stopped. Headache can occur, but this is rare. Severe complications, such as nerve damage and infection, are extremely rare.

Nerve blocks

You may be offered a nerve block to control your pain after surgery. Unlike an epidural, which controls pain over a broad area of your body, a nerve block controls pain isolated to a smaller area of your body, such as an arm or leg. Sometimes a catheter similar to an epidural catheter is placed for prolonged pain control. One advantage of using a nerve block is that it may allow the amount of opioid (narcotic) medication to be significantly reduced. This may result in fewer side effects, such as nausea, vomiting, itching, and drowsiness.

In some cases, a nerve block can be used as the main anesthetic for your surgery. In this case, you will be given medications during your surgery to keep you sleepy, relaxed, and comfortable. This type of anesthesia provides the added benefit of pain relief both during and after your surgery. It may reduce your risk of nausea and vomiting after surgery. You, your anesthesiologist, and your surgeon will decide before surgery if a nerve block is a suitable pain management or anesthetic option for you.

Pain medications taken by mouth

At some point during your recovery from surgery, your doctor will order pain medications to be taken by mouth (oral pain medications). These may be ordered to come at a specified time, or you may need to ask your nurse to bring them to you. Make sure you know if you need to ask for the medication! Most oral pain medications can be taken every 4 hours.

Important! Do not wait until your pain is severe before you ask for pain medications. Also, if the pain medication has not significantly helped within 30 minutes, notify your nurse. Extra pain medication is available for you to take. You do not have to wait 4 hours to receive more medication.

What are some of the risks and benefits associated with pain medication?

Opioids (narcotics) after surgery: medications such as morphine, fentanyl, hydromorphone

Benefits: Strong pain relievers. Many options are available if one is causing significant side effects.
Risks: May cause nausea, vomiting, itching, drowsiness, and/or constipation. Although these drugs carry a risk of abuse and addiction, the risk is manageable if the medications are used properly, for the right reasons, and for a short period of time.

Opioids (narcotics) at home (Percocet®, Vicodin® and others)

Benefits: Effective for moderate to severe pain. Many options available.
Risks: Nausea, vomiting, itching, drowsiness, and/or constipation. Stomach upset can be lessened if the drug is taken with food. You should not drive or operate machinery while taking these medications. Note: These medications often contain acetaminophen (Tylenol®). Make sure that other medications that you are taking do not contain acetaminophen. Too much acetaminophen can damage your liver.

Non-opioid (non-narcotic) analgesics (Tylenol® and other non-NSAIDS)

Benefits: Effective for mild to moderate pain. They have very few side effects and are safe for most patients. They often decrease the amount of stronger medications you need, which may reduce the risk of side effects.
Risks: Liver damage may result if more than the recommended daily dose is used. Patients with pre-existing liver disease or those who drink significant quantities of alcohol may be at increased risk.

Nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen (Advil® and Motrin®), naproxen sodium (Aleve®), celecoxib (Celebrex®) and others

Benefits: These drugs reduce swelling and inflammation and relieve mild to moderate pain. Ibuprofen and naproxen sodium are available without a prescription, but ask your doctor about taking them. They may reduce the amount of opioid analgesic you need, possibly reducing side effects such as nausea, vomiting and drowsiness. If taken alone, there are no restrictions on driving or operating machinery.
Risks: The most common side effects of NSAIDs are stomach upset and dizziness. You should not take these drugs without your doctor’s approval if you have kidney problems, a history of stomach ulcers, heart failure or are on “blood thinner” medications such as Coumadin® (warfarin), Lovenox® injections, or Plavix®.

Be sure to tell your doctor about all medications (prescribed and over-the-counter), vitamins, and herbal supplements you are taking. This may affect which drugs are prescribed for your pain control.

Are there ways I can relieve pain without medication?

Yes, there are other ways to relieve pain and it is important to keep an open mind about these techniques. When used along with medication, these techniques can dramatically reduce pain.

Guided imagery is a proven form of focused relaxation that helps create calm, peaceful images in your mind — a “mental escape.”

Relaxation media can be purchased at some bookstores or on-line stores, or can be borrowed from your local library. You can bring your relaxation media and listening device to the hospital to play prior to surgery and during your hospital stay.

For the best results, practice using the relaxation techniques before your surgery, and then use them twice daily during your recovery. Listening to soft music, changing your position in bed, or tuning in to a hospital relaxation channel are additional methods to relieve or lessen pain. Ask your nurse for channel information.

At home, heat or cold therapy may be an option to help reduce swelling and control your pain. Your surgical team will provide specific instructions if these therapies are appropriate for you.

If you have an abdominal or chest incision, you will want to splint the area with a pillow when you are coughing or breathing deeply to decrease motion near your incision. You will be given a pillow in the hospital. Continue to use it at home as well.

Lastly, make sure you are comfortable with your treatment plan. Talk to your doctor and nurses about your concerns and needs. This will help avoid miscommunication, stress, anxiety, and disappointment, which may make pain worse. Keep asking questions until you have satisfactory answers. You are the one who will benefit.

How can I control pain at home?

You may be given prescriptions for pain medication to take at home. These may or may not be the same pain medications you took in the hospital. Talk with your doctor about which pain medications will be prescribed at discharge.

Note: Make sure your doctor knows about pain medications that have caused you problems in the past. This will prevent possible delays in your discharge from the hospital.

Preparation for your discharge

Your doctors may have already given you your prescription for pain medication prior to your surgery date. If this is the case, it is best to be prepared and have your medication filled and ready for you when you come home from the hospital. You may want to have your pain pills with you on your ride home if you are traveling a long distance. Check with your insurance company regarding your prescription plan and coverage for your medication. Occasionally, a pain medication prescribed by your doctor is not covered by your insurance company.

If you don’t receive your prescription for pain medication until after the surgery, make sure a family member takes your prescription and either gets it filled at your hospital’s pharmacy or soon after your discharge from the hospital. It is important that you ARE PREPARED in case you have pain.

Make sure you wear comfortable clothes, and keep your coughing and deep breathing pillow with you.

You may want to have your relaxation music available for your travels.

If you are traveling by plane, make sure you have your pain pills in your carry-on luggage in case the airline misplaces your checked luggage.

While at home:

Remember to take your pain medication before activity and at bedtime. Your doctor may advise you to take your pain medication at regular intervals (such as every four to six hours).
Be sure to get enough rest. If you are having trouble sleeping, talk to your doctor.
Use pillows to support you when you sleep and when you do your coughing and deep breathing exercises.
Try using the alternative methods discussed earlier. Heating pads or cold therapy, guided imagery tapes, listening to soft music, changing your position in bed and massage can help relieve your pain.

NOTE: If you need to have stitches or staples removed and you are still taking pain medications, be sure to have a friend or family member drive you to your appointment. Commonly, you should not drive or operate equipment if you are taking opioid (narcotic)-containing pain medications. Check the label of your prescription for any warnings or ask your doctor, nurse, or pharmacist.

Frequently asked questions

I am nervous about getting addicted to pain pills. How do I avoid this?

With proper use, the risk of becoming addicted to pain medication after surgery is small. The bigger risk is a possible prolonged recovery if you avoid your pain medications, and cannot effectively do your required activities. If you are concerned about addiction, or have a history of substance abuse (alcohol or any drug), talk with your doctors. They will monitor you closely during your recovery. If issues arise following surgery, they will consult the appropriate specialists.

I’m a small person who is easily affected by medicine. I am nervous that a “normal” dose of pain medication will be too much for me. What should I do?

During recovery, your healthcare team will observe how you respond to pain medication and make changes as needed. Be sure to communicate with your doctors any concerns you have prior to surgery. The relatively small doses of pain medication given after surgery are highly unlikely to have an exaggerated effect based on your body size.

I don’t have a high tolerance for pain. I am afraid that the pain will be too much for me to handle. What can I do?

Concern about pain from surgery is very normal. The most important thing you can do is to talk with your surgeon and anesthesiologist about your particular situation. Setting pain control goals with your doctors before surgery will help them better tailor your pain treatment plan. Treating pain early is easier than treating it after it has set in. If you have had prior experiences with surgery and pain control, let your doctor know what worked or what did not work. Remember, there are usually many options available to you for pain control after surgery.

I normally take Tylenol® if I get a headache. Can I still take Tylenol for a headache if I am on other pain medication?

As discussed earlier, before taking any other medication, be sure to talk to your doctor. Some of the medications prescribed for use at home contain acetaminophen (Tylenol) and if too much is taken, you may become ill. In order to avoid getting too much of any medication, discuss this issue with your doctor BEFORE you leave the hospital.

How do I play an active role in my pain control?

Ask your doctors and nurses about:

Pain and pain control treatments and what you can expect from them. You have a right to the best level of pain relief that can be safely provided.
Your schedule for pain medicines in the hospital.
How you can participate in a pain-control plan.

Inform your doctors and nurses about:

Any surgical pain you have had in the past.
How you relieved your pain before you came to the hospital.
Pain you have had recently or currently.
Pain medications you have taken in the past and cannot tolerate.
Pain medications you have been taking prior to surgery
Any pain that is not controlled with your current pain medications.

You should:

Help the doctors and nurses “measure” your pain and expect staff to ask about pain relief often and to respond quickly when you do report pain.
Ask for pain medicines as soon as pain begins.
Tell us how well your pain is relieved and your pain relief expectations.
Use other comfort measures for pain control — listening to relaxation or soft music, repositioning in bed, etc.

Your doctors are committed to providing you with the safest and most effective pain management strategy that is most acceptable to you.

Remember:

Pain is different for everyone.
Pain may be dull, stabbing, cramping, throbbing, constant, on and off, etc.
Treating pain early usually brings quicker and better control.
Healing occurs faster when pain is under control.
Pain affects blood pressure, heart rate, appetite and general mood.

Skin Glue vs Stitches | Healing Your Child’s Wound

You know that feeling—when you least expect it, your child manages to get a deep cut—and you know you’re headed for a long night in the ER. The good news is that the field of Pediatrics has new and better ways to minimize pain and improve the cosmetic outcome of skin wound treatments.

Skin Glue

Skin glue is often an alternative to stitches. The main advantage of skin glue is that it is quick and virtually painless to use. Your child doesn’t need any injections of pain medication and there are no needles involved. Skin glue can be a great option for a young child who would have to be sedated or restrained for a repair with stitches. Sometimes the cosmetic outcome may not be as good as a sewn repair, especially if the wound is in a high tension area. There are times when skin glue may not be possible, or may not be the best choice. Wounds that usually are not closed with skin glue include:

Wounds that Require Stitches

1) Wounds in areas of high skin tension such as the arm, leg or forehead.

2) Wounds in areas that stretch, move, or change such as over joints.

3) Wounds within a hairline such as on the scalp or through an eyebrow.

4) Wounds that have a high risk of infection such as animal bites.

5) Wounds that are particularly deep or large or involve damage to underlying muscle or tendons.

6) Wounds to mucous membranes, lips, and genitalia.

Easing the Pain and Anxiety

Skin numbing cream is also available and, for smaller wounds, can be the only medication needed to numb the area before stitches. This eliminates the need for injectable numbing medicines. The down-side to skin numbing creams is that they have to sit for at least 20-30 minutes before they are fully effective. But for small wounds that are not a candidate for skin glue, numbing cream and a few dissolving stitches means a nice cosmetic outcome with little or no trauma. Some doctors will also give a small, weight-adjusted dose of a narcotic and/or anxiety medicine to help make the process easier.

For larger wounds that need a lot of stitches, some pediatric emergency rooms offer sedation. Your child can be put to sleep with IV medicine during the repair. If you think this might be necessary, call your ER first as not all facilities offer this service.

Minimizing Scars

Some, but not all, ERs have a plastic surgeon on call. Other ERs have a list of plastic surgeons that they can call but do not guarantee that a plastic surgeon will be available. If you think your child may need a plastic surgeon, consider calling your ER first to see what their policy is.

No matter how your child’s wound is repaired, it will scar. If you are displeased with the scar, you can always have it revised by a plastic surgeon. And remember, the summer sun is the worst thing for scars and prevents fading. Once your child’s wound is well healed, be sure to use liberal sunscreen every day.

Which Does My Child Need?

Which Does My Child Need?

Kids love to play. Between playgrounds, sports fields and the ins and outs of everyday activities, bumps, cuts and scrapes can happen. Every once in a while, medical attention is needed. Here are some common questions we get from parents about cuts, scrapes and scratches.

How do I know when my child’s cut needs medical attention?

Any open wound that you think may need to be closed should be seen by a doctor as soon as possible. Ideally, wounds should be checked and closed within about six hours to help prevent wound infections; however, some open wounds can be closed as late as after 12-24 hours.

In general, staples are only used to close cuts to the scalp. Skin glue is most commonly used on the face and sometimes on fingers and toes. Stitches (sutures) can be used on any part of the body.

Here are some indicators that your child may need to have a cut closed:

A cut is split or gaping.
A cut is longer than ½ inch (12 mm).
Cuts on the face that are longer than ¼ inch (6 mm) usually need closure with sutures or skin glue.
In the mouth, inside the lip or on the tongue, cuts less than 1 cm usually do not need stitches unless the cut continues to bleed.

What is the process of getting stitches at After Hours Pediatrics Urgent Care?

Here is our typical process for evaluating and treating your child’s wounds:

A provider evaluates the cut to assess the need for wound closure. If the provider deems that repairing the cut may be complicated, you may be referred to an Emergency Department for your child’s wound care.
A numbing cream is applied over the cut, which avoids the need for a numbing shot in most patients. The cream takes about 30 minutes to work.
The wound is cleaned.
The provider will discuss wound repair options with the family (and the child, if appropriate), as well as evaluate the best ways to assure that the child is as comfortable as possible during the procedure.
- Injectable local numbing medications can be used if the numbing cream doesn’t work well enough.
- A nasal spray containing a safe, mild, short-acting sedative that doesn’t put him or her to sleep can be used. It takes the edge off of the child’s anxiety and can help to keep them from remembering stressful parts of the procedure.
We conduct the wound closure procedure while educating your family through the process to reduce any anxiety or fear. Family members may stay in the room during the procedure and often can help keep the child calm and distracted.
We apply a dressing to the area and instruct the family on how to care for the wound. We often use absorbable suture material on the face, which means the child won’t have to go through the potential stress of having the stitches removed.

What is skin glue?

Skin glue, such as Dermabond, is sometimes used to close wounds. Doctors apply the liquid on small, superficial wounds to securely hold the edges together.

Your doctor will evaluate your child’s wound before making the decision whether to use skin glue or regular stitches, since there are many factors that need to be considered before choosing one or the other. Skin glue is most commonly used on the face, fingers and toes. It is not suitable for use with large or deep cuts or over areas close to joints.

At After Hours Pediatrics Urgent Care, our goal is to make sure your child’s wounds get the right care to encourage good wound healing and minimize scarring, and to do so in a way that causes as little stress as possible, not only for our patients, but also for those who care for them.

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Treatment of pain associated with operations

This patient guideline is based on the Estonian treatment guideline “Perioperative management of acute pain”, approved in 2016. Treatment guidelines were compiled from a literature review based on scientifically proven evidence. The aim of the patient guide is to help patients manage postoperative pain and to provide answers to questions related to acute pain. Knowledge of pain management options helps patients actively participate in treatment.The importance of the topics covered in the patient guide, as well as the accessibility of its text, were assessed by patients with acute postoperative pain. The patient guide explains the following topics: what is acute postoperative pain, why is it important to treat acute pain, and how to measure it. Different chapters describe options for treating acute postoperative pain. The reader will receive an answer to the following questions: why the use of oral drugs is preferred for the treatment of pain, whether it is possible to take different pain relievers together, and what else can be done in addition to drugs to relieve pain.It also provides guidance on how to manage postoperative pain at home. The topics covered in the patient guide can be read in more detail on the web pages at the end of the guide (see Appendix 1).

Tell your doctor what medications (including pain relievers) you have used before, if you are allergic to any medications and if you have any side effects. This information is very important when prescribing the right pain reliever for you.
If you feel pain, tell the nurse right away. Report pain also when pain is mild or at night.
If you have any side effects with any medication, tell your nurse or your doctor right away.
Rate your pain on a ten-point scale, because based on the information received, it will be possible to provide you with the medicine for pain that is right for you. Do not exceed the maximum allowable daily dose of pain relievers.
If the pain relievers prescribed for you do not relieve the pain during home treatment, and the pain intensity on a ten-point scale is still greater than five after taking pain relievers, please contact your family doctor or attending physician.
For mild to moderate pain, use alternative pain relievers in addition to pain medication.
During the period after surgery, it is important to be active and move as much as possible, this will help the body to recover and reduce the occurrence of complications.
If pain interferes with movement, report it to the nurse.

What is acute postoperative pain?

Pain is a subjective and unpleasant sensation that affects consciousness and impairs well-being. Acute pain is short-term, most often it has a well-defined area, a certain time of onset, as well as subjective and objective physical signs: heart rate and breathing become more frequent and blood pressure rises.Severe pain interferes with sleep and creates feelings of fear and anxiety. Acute postoperative pain occurs due to a surgical procedure or surgery. The severity of pain depends both on the severity of the operation and the size of the surgical wound, and on the pain threshold of a person. People feel and react to pain in different ways. Pain can also be influenced by the patient’s early pain experience, age, gender, cultural background, and psychological factors. In the case of children, pain can also be influenced by their parents’ attitude towards pain.

Why treat acute postoperative pain?

Postoperative pain does not need to be tolerated, as pain may increase the incidence of postoperative complications: recovery from surgery will be slower and therefore may increase the length of hospital stay. If the pain is not treated, chronic postoperative pain is more common. Effective treatment of postoperative pain relieves heart and lung function, reduces the risk of venous thrombosis, and helps normalize digestion.

How is the intensity of pain assessed?

Assessing the severity of pain after surgery is a routine part of patient follow-up work. Pain is assessed regularly, and the frequency of the assessment depends on the patient’s condition and the severity of the surgery. Since the sensation of pain is individual and subjective, only you yourself will be able to assess the strength of the pain experienced. The nurse will assess your pain regularly, both before and after taking pain relievers, both during rest and while moving. Based on the information received, it will be possible to draw up a pain treatment scheme that suits you personally.

Different pain scales are used to assess pain. For example, the scale for the numerical rating is used in adults. It is used to assess the severity of pain on a ten-point scale, where zero means that there is no pain, and 10 means the most severe pain you can imagine. The patient is asked to rate pain experienced in the past 24 hours using three different methods.
Rate:

force of existing pain,
the weakest feeling of pain and
is the most intense feeling of pain.

The arithmetic mean of the scores received will show the strength of the patient’s feeling of pain during the last 24 hours. Sometimes you are asked to choose words that would describe your pain. These words can be:

no pain
slight pain
moderate pain
severe pain
very severe pain
unbearable pain

Figure 1.

Numeric Pain Rating Scale Sometimes the face scale (FPS-R) is used to assess pain (see Figure 1).Figure 2) or the so-called face scale. This scale can be used, for example, in older children. The child will need to explain the face scale so that he can use it to assess his pain. The child will need to explain the scale as follows: “This face (point to the leftmost face) shows that there is no pain at all. Other faces (point to each face from left to right) show that the pain is getting worse and worse. The face on the far right shows that he is in great pain. ” After the explanation, the child can be asked which face shows how much it hurts now?

According to the person chosen by the child, the assessor will be able to give the indicated pain a score of 0, 2, 4, 6, 8, or 10 points, counting from right to left: 0 = not painful at all.10 = very painful. You cannot use the words “sad” or “joyful” in your assessment. It is imperative to clarify that we are talking only about how the child feels, and not about the external expression of the face.

Figure 2. Facial scale for assessing pain intensity ( FPS-R )

The above scales are used not only to assess pain in older children, but also for patients with mild to moderate mental disorder. For young children, infants and patients with severe mental disorders, a behavior scale is used, in which case the nurse assesses the severity of pain. These pain scores take into account the vital signs of patient , such as heart rate, blood pressure, blood oxygen content and behavior (facial expression, anxiety, sleep).

To achieve the best result in the treatment of pain immediately
inform the nurse if you feel pain – even when the pain is mild or if it started at night.
Do not endure pain!

How to treat pain after surgery?

In the treatment of postoperative pain, different medications are used with different routes of administration.In addition, the use of alternative methods is allowed, which can be used in case of mild to moderate pain.

It is important to know which medications (including pain relievers) you have already used, if you are allergic to medications and if you have any side effects, in order to prescribe the appropriate treatment for pain. When prescribing a medicine, modern principles from the medical field are taken into account regarding the operation performed to you and painkillers.

The choice of a suitable pain reliever, the dose of the medication and the duration of treatment depends on both the severity of the pain (mild, moderate or severe pain), the type of pain (whether there was, for example, wound pain or nervous pain), the person himself (elderly, child, pregnant and dr.), as well as from concomitant diseases.

To achieve the best effect of pain relievers, take medication regularly (at regular intervals). Pain relievers of different effects are often combined.

Groups of painkillers

As pain relievers, drugs are used, which are divided according to the type of mechanism of action into three main groups:

Simple pain relievers. For example, paracetamol, ibuprofen, and diclofenac.
Opioids. Medicines in this group are divided into weak opioids – for example, tramadol, codeine, and strong opioids – for example, morphine.
Supportive medicines. They are used, for example, to treat nervous pain.

Paracetamol

Paracetamol is often the first choice for mild to moderate pain. Paracetamol differs from other pain relievers (for example, from ibuprofen and diclofenac) primarily in that it does not have an irritating effect on the mucous membrane of the digestive tract.Side effects are rare when taking paracetamol. The most severe possible side effect is liver damage, which is rare and occurs most often due to drug overdose. Paracetamol should be used with caution in liver and kidney failure, chronic malnutrition, or alcoholism. The child should be prescribed paracetamol according to his age and weight.

If medications are additionally used (for example, the so-called teas for influenza), which include paracetamol in combination with an anesthetic, you need to ensure that the amount of paracetamol taken per day does not exceed the permitted daily dose (for adults, 4 grams per day).

Nonsteroidal anti-inflammatory drugs or NSAIDs (ibuprofen, diclofenac, ketoprofen, dexketoprofen, naproxen, etc.)

If the analgesic effect of paracetamol is too weak (an hour after taking paracetamol, the pain intensity is still more than five points), then in case of mild or moderate pain, for example, ibuprofen, ketoprofen, naproxen, diclofenac or other drugs from the same group should be taken according to the instructions for use the medicine listed on the medicine information sheet.

These drugs have analgesic, antipyretic and anti-inflammatory effects, but their use is contraindicated in case of gastrointestinal ulcers. These medicines should be used with caution by patients who have cardiovascular diseases. The risk of side effects in the digestive tract is greater in older people and in those who take large amounts of NSAIDs. The occurrence of side effects in the digestive tract does not depend on the way the medication is taken – medicinal suppositories with NSAIDs and injectable forms of drugs are also not suitable for patients with ulcers in the digestive tract.The strength of the harmful effect on the digestive tract differs for different drugs of the NSAID group. Ibuprofen is believed to be the least harmful to the digestive tract.

Depending on what concomitant diseases you have, some pain relievers belonging to this group may be more suitable for you than others, and this must be taken into account when prescribing treatment. For children, ibuprofen is most often used, it is prescribed according to the age and weight of the child.

Opioids or narcotic pain relievers (codeine, tramadol, morphine, fentanyl, oxycodone, pethidine, etc.)

In the case of severe pain, opioids are used in addition to the aforementioned groups of drugs. Common side effects of opioid use are nausea and vomiting. The nausea-inducing effect of opioids is weakened by long-term use. Constipation is another common side effect.

Supportive medicines such as gabapentin, pregabalin.

Supportive drugs are drugs that were not originally developed as pain relievers, but were later discovered to be useful in relieving certain types of pain. For example, gabapentin and pregabalin were originally used to treat epilepsy. These medications are often used to treat chronic nerve pain. They are also effective in treating postoperative pain, reducing pain and the need for other pain relievers.

If you experience any side effects, notify your nurse or doctor right away!

After surgery, pain relievers can be taken:

mouth
by injection into a vein or muscle
via epidural catheter
with medicinal candle

Oral pain relievers are preferred after surgery.Oral medication is as effective as injected medication without pain or injection-related complications such as hemorrhage, inflammation of the injection site. Oral pain relievers are suitable for all types of pain relief, but you must be able to eat and drink.

Vein injection

If you cannot take the pills by mouth because of the operation, the nurse will inject your medicine through a cannula into a vein.The pain relieving effect will come within a few minutes. Once you start eating and drinking, you can return to your pill medication again.

After a major and painful operation, pain relievers can be taken using a special pain pump, with which you yourself can adjust the dose of the pain reliever (opioids) in the vein. This is called Patient Controlled Pain Relief or PCA (short for Patient Controlled Analgesia).

For taking painkillers, use a special pump that will allow you to receive painkillers as soon as you feel the need. The doctor will calculate the appropriate dose of the medicine for you and enter it into the pump’s memory. If you feel pain, press the button and the pump will inject the appropriate amount of medication through the cannula into the vein. There is no danger of medication overdose as the pain pump is programmed according to your needs.

The pump button must be pressed by yourself, you must not let anyone else do it.If the dose of the medication calculated for you is not sufficient and does not relieve pain, inform your nurse or doctor, who will adjust the dose of the medication given according to the severity of the pain. The PCA pump is also used for children if the child is old enough to use it and is able to understand how the pump works.

Figure 3. PCA pump

Muscle drug administration

The administration of painkillers by injections is tried to be avoided, since, due to heterogeneous absorption, the effect of anesthesia may be less than the expected effect.In addition, the injection can be painful.

Drug administration using medicinal suppositories

Sometimes, if taking painkillers by mouth for some reason is not possible, medications can also be taken through the rectum. Medicated suppositories are often used to relieve pain in young children.

Medication via epidural catheter

Using local anesthesia, if necessary, the anesthesiologist will place a thin plastic tube (epidural catheter) in the epidural space surrounding the spinal canal before the operation.The epidural space is located in the spinal canal, where the roots of the nerves that transmit the feeling of pain pass. The medicine injected there affects the roots of the nerves and thus prevents the spread of the pain pulse. Therefore, the introduction of drugs into the epidural space is one of the most effective methods of pain relief.

Opioids and local anesthetics – a mixture for local anesthesia – are continuously injected into the epidural catheter through an automatic syringe throughout the day. The analgesic effect begins no later than 20 minutes after the start of the medication.

Figure 4. Inserting an epidural cutter

Epidural pain relief can cause:

Nausea and vomiting – these are helped by anti-nausea medication
Weakness and numbness of the legs – they go away on their own
Violation of urination – if necessary, a catheter is placed in the bladder
Decrease in blood pressure – blood pressure is monitored regularly
Head or back pain – tell your nurse or doctor.If a headache occurs after surgery while undergoing home treatment, contact your doctor immediately.

Nerve plexus block

Nerve plexus blocks are used most often for anesthetizing the extremities. Blockages are done both with a single injection and with the use of a catheter, which is installed next to the nerve plexus, and is needed for the constant administration of the drug (local anesthesia).Medications are injected through the plexus catheter either with a single injection or with an automatic syringe.

The effect of alternative pain treatment methods on postoperative pain is small, therefore you should not use such methods separately, but only together with pain relievers. Alternative methods reduce anxiety and feelings of tension throughout the hospital stay. Most methods, such as music therapy or distraction, are safe and can be used without special training or additional tools.If the pain is mild or moderate, then in addition to pain relievers, you can use the methods from the list below. For more information on the different methods, ask your ward nurse.

Cold compress

Cold leads to constriction of blood vessels and bleeding in the damaged area slows down. If you have no contraindications, you can use a cold compress to reduce swelling and pain in the area of the operation. As a cold compress, you can use special gel packs sold in pharmacies, any packaging from the freezer is also suitable.Wrap the cold bag in a towel and then place it on the damaged area and fix the compress if necessary. The towel will protect fabrics from possible local exposure to cold. Keep the cold compress in place for 20-30 minutes in a row, then pause for 10-15 minutes and repeat the procedure if necessary.

Transcutaneous electrical nerve stimulation or TENS

TENS, or transdermal electrical nerve stimulation, is a pain management method in which electrical impulses are used to relieve postoperative pain.

Physiotherapy

Physiotherapy is recommended to be added to the postoperative treatment regimen, as it reduces the risk of complications and facilitates the recovery of the body after surgery. Physiotherapy is performed by a specialist. He will explain to you why you need to start moving as quickly as possible after the operation, teach you how to take the most comfortable and relaxed posture after the operation, how to prop your body with pillows or the operating area with a bandage.In addition, he will teach you breathing techniques, as well as movement exercises.

Music therapy

Listening to music reduces anxiety, slightly reduces the severity of postoperative pain, and the stress response associated with pain is less common with music. Therefore, the need for opioids is also reduced.

If you enjoy listening to music and it relaxes and calms you down, then we recommend that you take your favorite music with you to the hospital with you.You just need to remember that your favorite music may not be liked by other patients, so we recommend that you use headphones when listening to music.

Psychological Methods

These include various relaxation techniques, daily self-activity training, distraction, and positive visualization techniques.

Using a variety of psychological techniques throughout your hospital stay can help reduce feelings of tension and anxiety.With the help of them, you will more easily cope with the situation that has arisen. Both the severity of pain and the need for pain relievers will decrease to a small extent.

For distraction, you can solve crosswords, put puzzles, play electronic games, etc. You can also use relaxation techniques to relax specific muscles or to reduce general feelings of anxiety and tension.

In the case of children, it is also important to use different psychological techniques to reduce feelings of anxiety and pain, and to do this throughout the entire hospital stay.The child becomes more calm if he is already explained to him what awaits him before admission to the hospital.

Play is an effective method of distracting attention for a child: both during the postoperative period and during procedures. Games in which the child will be an active participant (for example, electronic games) are more effective than the usual distraction.

Listening to your favorite music is particularly good at reducing pain and anxiety in older children.For newborns, physical contact is important (being on the breast of mom or dad), the benefits for reducing pain during procedures and after surgery will be from massage, and from breastfeeding, and from sucking the nipple.

When you are discharged from the hospital, you will be given recommendations on how to treat pain at home: what painkillers you may need, how much and how often you will need to take them. They will also tell you about possible side effects and what to do if they occur.Pain relievers for home use may not necessarily be the same as those you received at the hospital.

Ask your doctor where you can go if you have a problem. Make sure your doctor is aware of which medications have previously caused you problems. This will help avoid possible complications associated with medications.

Houses:

Take pain relievers regularly as directed by your doctor. You can always check information about the prescribed prescriptions, including the regimen for taking the medicine prescribed by your doctor, in the prescription center of the state portal (www.eesti.ee → Services → Citizen → Health and healthcare → Prescriptions).
Get enough rest. If you have trouble sleeping, tell your doctor.
While sleeping or doing deep breathing exercises, prop your body with pillows.
To reduce pain, you can use alternative methods approved by your doctor: cold or warm compresses, listening to music, massage, substitution therapy (being in a position that relieves pain, supporting the body with pillows, etc.)
If you have to use opioids at home to treat acute postoperative pain, then driving will be prohibited, and you will not be able to use devices / mechanisms that require special attention.
If the pain relievers prescribed by your doctor do not relieve your pain (the pain is still greater than five on a scale of ten), then contact your doctor or family doctor.

In Estonian and Russian:
www.regionaalhaigla.ee/et/valuravi
www.valu.ee
Website of the Estonian Association of Anesthesiologists
video: Amanda goes to surgery

In English:
www.mayoclinic.org/pain-medications/art-20046452
www.preop.com.au/postop.htm
www.cuh.org.uk/sites/default /files/publications/PIN1304_TENS_pain_service_v4.pdf
patient.info/health www.painaustralia.org.au/healthcare-professionals/patient-resources.html

Used literature

Allred KD, Byers JF, Sole ML. The effect of music on postoperative pain and anxiety. Pain Manag Nurs Off J Am Soc Pain Manag Nurses. 2010 Mar; 11 (1): 15-25.

Crowe L, Chang A, Fraser JA, Gaskill D, Nash R, Wallace K. Systematic review of the effectiveness of nursing interventions in reducing or relieving post-operative pain. Int J Evid Based Healthc. 2008 Dec; 6 (4): 396-430.

Engwall M, Duppils GS. Music as a nursing int ervention for postoperative pain: a systematic review.J Perianesthesia Nurs Off J Am Soc PeriAnesthesia Nurses Am Soc PeriAnesthesia Nurses. 2009 Dec; 24 (6): 370–83

Johansson K, Nuutila L, Virtanen H, Katajisto J, Salanterä S. Preoperative education for orthopedic patients: systematic review. J Adv Nurs. 2005 Apr; 50 (2): 212-23

Macintyre PE, David A Scott, Stephan A Schug, editors. Acute Pain Management: Scientific Evidence (3rd edition) 2010.

Vaajoki A, Pietilä A-M, Kankkunen P, Vehviläinen-Julkunen K. Effects of listening to music on pain intensity and pain distress after surgery: an intervention.J Clin Nurs. 2012 Mar; 21 (5-6): 708-17.

Wood S. Postoperative pain 2: patient education, assessment and management. Nurs Times. 2010 Nov 23; 106 (46): 14-6.

IASP Taxonomy. (2012). International Association of the Study of Pain.
www.iasppain.org/Education/Content. aspx? ItemNumber = 1698 & navItemNumber = 576 # Paintolerancelevel

New technology of pain relief after cesarean section

A year ago, for the first time in the Urals, the technology of additional postoperative anesthesia for women who had undergone cesarean section was introduced at City Clinical Hospital No. 40.The new technology has already helped 150 women in childbirth with a history of gynecological interventions, including a cesarean section.

Anesthetic drug is delivered through a microinfusion pump to the incision (suture) area. Unlike a narcotic analgesic of general action, there is no dizziness, nausea, drowsiness, anesthesia is local: the drug practically does not enter the bloodstream and does not affect lactation, but relieves pain effectively and for a long time. The medicine is “pumped” by the pump in a given mode, like insulin in diabetics.

This type of pain relief significantly affects the well-being of women in childbirth in the first 24-48 hours after the intervention, the most difficult after a cesarean section. It is especially recommended to resort to additional anesthesia for women in labor who have previously undergone operations on the abdominal organs (surgical, gynecological, urological, obstetric).

It is difficult to overestimate the importance of new technology. In recent decades, there has been a trend towards an increase in the number of cesarean sections.If only 10-15 years ago, on average, only 25% were “caesarean”, now more than 40% of all deliveries in the perinatal centers of Russia are performed using a caesarean section (CS). In ordinary maternity hospitals, as well as in City Clinical Hospital No. 40, this figure is now 35-37%.

The introduction of an additional method of postoperative anesthesia in City Clinical Hospital No. 40 helps women to feel the first hours of motherhood as an unclouded joy. Every year, more than 5 thousand newborns are born in our maternity hospital, of which from 2 to 2.4 thousand – as a result of a cesarean section.

This technique, which has already entered all modern international recommendations, is implemented in Yekaterinburg only in the maternity hospital GKB 40.

A client of the maternity hospital GKB 40 – about additional anesthesia

Maria Valerievna, mother of two children. She gave birth to the second in City Clinical Hospital No. 40 in May 2018 (Review is published with the consent of the client of the maternity hospital)

– I learned about this service long before the birth, on a traditional excursion to the maternity hospital and “first-hand”. Expectant mothers have the opportunity to talk with the deputy chief physician for obstetrics and gynecology, Oleg Butunov.He spoke about additional pain relief. In medical terms, this is called long-term local analgesia of the suture after cesarean section.

My first birth took place in America in 2012, there was also a cesarean section, and then I was not offered anything like that. In GKB 40, it is definitely not worse. Before the operation, everything was explained in detail: the effect of the drug, how it will be administered, the expected effect. And so it all happened. After the operation, the pain syndrome was insignificant and, as they explained to me, it was associated with an incision and intervention on the uterus, its contraction.The seam on the abdomen did not bother or hurt.

Literally from the first hours, I devoted myself entirely to the child, and throughout my stay in the hospital I took care of it myself. Recovered quickly. She was discharged in the usual (for women after cesarean) period – on the fourth day after the operation.

I advise everyone to use this opportunity! Don’t take the pain. Let your strength be completely surrendered to your baby. When a mom takes care of herself, she is actually taking care of the newborn.

On the issue of pain relief during delivery and in the postoperative period, the head of the department of anesthesiology and resuscitation number 2, candidate of medical sciences Dubrovin Sergey Germanovich advises.Registration by phone: 297-98-75.

Federal Center for Cardiovascular Surgery (Khabarovsk)

Recovery after cardiac surgery
Healthy lifestyle pages

Before leaving the clinic after surgery, you will be given advice on how to behave in the first time, which lasts from 2 to 6 months. There may be periods of improvement and deterioration during the healing process that are expected and should not be alarming to the patient.For those who underwent surgery using minimally invasive technologies, this period is much shorter.

Typical instructions are:

– Pain Relief
– return to physical activity
– sports and housework
– diet, sleep, emotional background
– follow-up after surgery

Take care of the joint

Before you are discharged, they will definitely tell you how to care for your suture. In most cases, the patient is discharged after the stitches and / or staples have been removed.In some cases, the removal of the stitches is not required – the stitches dissolve on their own after 2 months. Feelings of loss of sensitivity, itching and pain at the site of surgery may occur over time.

The following is very important

Keep the seam area clean and dry.
Use only soap and water to wash this area.
Do not use ointments, oils, rubbing or compresses unless specifically instructed to do so.
Eat healthy foods to speed up your recovery.

How to shower

If your seam is healing and dry, then you can take a “quick” shower (no longer than 10 minutes). If you have stitches on your chest, stand with your back to the shower.

If you do not have a shower, you can take a sitz bath without submerging the seam under water. And don’t get wet in the bathroom, but wash.

Water should be warm – not hot or cold.Water that is too hot or too cold can cause fainting.

How to wash the seam area

Use regular soap, no perfume soap or gel. Do not use a new brand of soap during your recovery – use a proven one.
Wet your hand or a washcloth with soapy water and gently wash the seam area up and down. Do not scrub the seam area with a washcloth until all crusts have come off and the seam is completely healed.

Call your doctor if signs of infection appear

Increased discharge from the wound
The edges of the wound parted
Redness and swelling appeared in the suture area.
The body temperature has risen (above 38 degrees Celsius)
If you have diabetes and your blood sugar is much higher than normal.

Pain relief

At first you will have discomfort in the muscles of the chest, in the area of the seam and in the chest as a whole with active movement.Itching, a feeling of stiffness in the suture area, or sensory disturbances are normal after surgery. You should not have chest pain similar to what you experienced before surgery. Pain relievers and anti-inflammatory drugs will be recommended before you leave.

If you had a CABG operation, then in addition to painful sensations in the chest, you will have painful sensations in the leg (from where the vein was taken for shunts). Daily walks, moderate activity, and time can help you cope with leg discomfort.

Be sure to consult a doctor if you develop mobility in the sternum or clicking in the sternum when moving.

Swelling

You will return home with slight swelling in your legs and feet, especially if you have had a vein for shunts. If you notice swelling:

When resting, try to keep your leg (s) elevated. The easiest way to do this is to lie down on a sofa or bed and put your feet on a few pillows.Or lie on the floor and put your feet on the couch. Do this three times a day for an hour and the swelling will noticeably decrease. (Important: just lying on your back, you do not raise your legs enough).
Do not cross your legs when sitting
Walk daily, even if your legs are swollen
Use compression stockings or elastic bandages
It is necessary to bandage the operated leg within 6 weeks from the date of operation
The leg should be bandaged up to the knee.No need to bandage above the knee, even if the postoperative suture continues above it.
Bandages should be removed at night. This time can be used to wash them for reuse.

See your doctor if the swelling in your legs increases sharply and soreness appears, especially if it is accompanied by shortness of breath on movement.

Medicines

You will need medication after your surgery.Your doctor will tell you how long you have to take the drugs – only the first time or for life. Make sure you understand the names of the drugs, what they are for, and how often you should take them. Take only the drugs that have been prescribed for you. Talk with your doctor about the pre-surgery medications you need to take. Do NOT take new medications (dietary supplements, pain relievers, cold medications) without consulting your doctor or increase the dosage of old ones.

Driving

Your doctor will tell you when you can return to driving.This is possible after your sternum begins to heal and reflexes are fully restored. This usually takes up to 9 weeks after surgery. Until that moment, you can be a passenger as long as you want. If you decide to take a long trip in the first nine weeks after surgery, stop every hour and walk for 5-10 minutes.

Return to work

You need time to recover. It usually takes 6-9 weeks. Your doctor will tell you when you can return to work.If it is possible to apply flexible working hours, then it will be easier for you to return to normal work rhythm. If possible, build up the load gradually.

Activity

For the first 6-9 weeks:

Gradually increase the load. You can do light housework, but don’t stand in one place for more than 15 minutes.
It is important to observe the symmetry of the loads on the shoulder girdle – for example, always lean with both hands when getting up from the chair, thereby eliminating the distorting loads on the sternum.
Do not lift objects heavier than 5 kg (if necessary, this figure can be changed by your doctor). Also, do not pull or push heavy objects.
You can easily do exercises with your arms above shoulder level – pulling out something, combing your hair. But do not keep your hands up for a long time.
Some items can be deleted or new ones added, but only by your doctor. Remember to rest if you are mildly tired.Do not walk up and down stairs several times a day, even if it seems easy to you and, especially, on your first visit home. It is much better to plan your day so that you go down the stairs in the morning and climb up in the evening.
Do not overexert yourself – distribute the load evenly throughout the day. If you are tired, take a rest and reschedule the unfulfilled exercises for another time.
Walk daily. Your doctor or rehabilitation instructor will explain in detail how and how much to walk properly when you return home.
Get enough sleep. If you feel tired, go to bed earlier. Do not nap during the day, otherwise it will be difficult for you to sleep.

Sex

Many patients and their partners are worried about continuing their sex life after heart surgery. The amount of energy required to have intercourse with your partner is equal to the amount of energy expended to climb one or two flights of stairs or walk a distance of about 1 km at a fast pace.If you cannot afford such a load without fatigue and shortness of breath, please do not rush to return to your previous sex life, wait until you recover. For the first 6-9 weeks, select positions with the least amount of stress on the sternum, arms, and chest.

Remember that there are two sides to a sexual relationship – physical and emotional
Speak openly with your partner
Gradually pick up the pace in sexual relations
Have sex only when you feel rested and physically comfortable
Set realistic goals for yourself – it will take you time to get back to an active sex life
Maintain honest and loving relationships

And soon you and your partner will return to a satisfying emotional and physical relationship.Anxiety on the part of one of the partners can interfere with sexual satisfaction. Discuss any problems with your doctor.

Sport

Any sports activity, with the exception of walking, can be allowed only after consultation with a cardiologist or family doctor. Physical activity should be increased gradually, moving from light exercises to more complex ones.

It is recommended to walk in the morning and evening, in good weather, preferably on level ground, without significant climbs.

Heavy lifting

Lifting heavy objects over 5 kg should be avoided. Within 3-4 months after the operation (this is necessary for the complete healing of the sternum).

Housework

In the first phase, you will only be able to do light household chores such as vacuuming and helping with food preparation. Gradually, it will be possible to increase the amount of housework. Work that requires physical effort should be avoided.

Stairs and ramps

Climbing stairs requires more effort than walking on level ground. Climb and descend stairs with rest stops. Climbing an incline requires the most effort. You should ascend gradually with stops for rest.

Reception of guests

During the initial period of your stay at home, it is advisable to ask relatives and friends to reduce visits, which are significantly tiring.

It is advisable to reduce visits to young children who may carry various viral infections.

Posture

Postoperative changes in posture are possible: the shoulders are tilted forward, the back is hunched over due to weakness and pain.

You should constantly try to straighten your back and straighten your shoulders.

Travel abroad

Before you plan a flight or trip abroad, it is worth consulting with your doctor.

Cardiological rehabilitation

For many people with coronary artery disease, the cardiac rehabilitation program provides an excellent opportunity to learn a set of necessary exercises, learn more about heart disease and change their lifestyle to prevent further development of the disease.

Your family doctor can give you information about similar programs at your place of residence (the system of cardiological sanatoriums is in the introduction of the Social Insurance Fund).

Diet

You should eat healthy foods and they will help you recover faster.Your doctor will tell you if you need a special diet. It is normal if you have decreased appetite after surgery. This is an extra reason to eat more often, but in smaller portions. Your appetite will return in a few weeks. If this does not happen, see your doctor.

Sleep

It is very important to get enough rest to avoid overwork. Unfortunately, many patients experience sleep disturbances after surgery. Normal sleep patterns will return in a few weeks. See your doctor if lack of sleep is affecting your behavior or if your sleep patterns are not getting back to normal.

Emotions

It’s okay if you feel upset or depressed after you leave. These emotions can be related to the fact that you do not know what to expect or what may happen, or as a result of fatigue from a little exertion. Temporary low moods are normal and will gradually go away as you get into your daily life and work.

However, sometimes a depressed mood can inhibit your return to normal life.If the depressed mood only intensifies and is accompanied by other symptoms that accompany you every day for more than a week, you need treatment with a specialist.

To find emotional balance:

Dress everyday
Walk daily
Return to your hobbies
Share your feelings and experiences with others
Go to visit, at first limit visits to 15 minutes.Then extend them depending on how you feel
Get enough sleep at night

Join a cardiac rehabilitation group, take a trip to a sanatorium.

More serious reasons for specific treatment

You have suicidal thoughts. Suicide is not a solution to the problem, it only hurts your family and friends. If you have suicidal thoughts, see your doctor, or the dedicated 24/7 service, or go to the nearest hospital.
Your negative thoughts have been present for a long time.
You don’t have anyone you can trust. If you have no one with whom you can share your thoughts and experiences, it is difficult to assess the reality of your fears.

Without treatment, depression will only worsen. For “heart” depression may result in the development of a heart attack. Your doctor may refer you to a specialist to determine the treatment you need.

Mental health and heart surgery

Many patients are upset because they feel memory impairment after surgery, and sometimes a decrease in intelligence.These cognitive changes are normal after heart surgery. The entire body, including the brain, undergoes severe stress during surgery, especially if surgery requires cardiac arrest and the use of a heart-lung machine. As a rule, normal cognitive function is restored over time. The patient should avoid getting upset about this side effect of the surgery. You do not have to force yourself to solve more and more difficult tasks for the brain, and avoid (at first) mental overexertion.

Follow-up after surgery

All information about the examinations carried out with us, the operation and the postoperative course is sent to your cardiologist / therapist at the place of residence. You must contact him immediately upon arrival home. You should visit your cardiologist / therapist periodically, even if nothing bothers you, so that the specialist monitors your progress and, if necessary, makes adjustments to the therapy you receive.Finally, it will determine the time for you when you can start work and return to driving. Your doctor will tell you how often you should visit him. It is also important to have regular supervision at our Center (on the basis of the advisory department). As a rule, this happens once a year. Do not forget to make an appointment with your doctor in advance.

Follow all the doctor’s requirements regarding risk factors for the progression of your disease: watch your cholesterol levels, blood pressure, weight and smoking.Your doctor may periodically analyze the development of your disease, the rate of recovery. To do this, try, if necessary (if the doctor called you) to appear at the clinic for examination.

If you have had an operation on the heart valves, you need to prevent the occurrence of any type of infection in order to prevent the development of infective endocarditis. This includes taking antibiotics before you have any invasive procedure, dental procedure, or surgery.Your doctor will explain in more detail how to reduce the risk of complications.

Conclusion

Each patient returns to the volume of their usual activity at their own individual pace. You should not compare yourself to other heart surgery patients and compete with them.
If you have any problems related to the previous operation, do not hesitate to contact your doctor or cardiologist.
In a moment of fatigue, leave your guests and lie down to rest.Cut back on visiting friends.
Try to rest at noon.
For some time, the pain in the area of the postoperative stitches will interfere with your sleep. Listen to the radio or music to distract yourself, or get up and walk for a bit and then try to go back to sleep. Use sleeping pills only last.
The convalescence period is characterized by frequent mood swings that pass over time.
Walking on level ground is recommended.Choose your walking route. Walking should be fun. One should not walk until tired. Try to rest on the way.
It is recommended to wear cotton or knitted clothing that does not irritate the postoperative scar.
It is important to tell every doctor you see that you have had open heart surgery.

90,000 best methods of rehabilitation after surgery

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Recommendations after surgery – Arte dental clinic dental clinic

Please, before starting treatment after surgery, make sure that you clearly understand all the doctor’s recommendations.

Sometimes, after surgical interventions in the oral cavity, the patient may be disturbed by pain, swelling, bleeding.

Important!

If any of the following problems occur after surgery, consult a doctor IMMEDIATELY

Bleeding for 4 or more hours after the end of surgery
Nausea
Vomiting
Increase in body temperature
Pain that does not improve 24 hours after surgery
Increasing edema 72 or more hours after surgery

Prevention of pain

Before any intervention, “freezing” (local anesthesia) is performed, so the area of intervention is numb.There is a feeling of swelling.

The duration of numbness (anesthesia) depends on the type and amount of “freezing” (anesthetic). While the anesthetic is in effect, you may involuntarily bite your cheek, lip, or tongue. The effect of anesthesia ceases completely after a few hours. Try not to eat until the anesthesia is completely gone.

Slight pain in the area of surgery is a normal reaction after the numbness stops. The most intense pain lasts 24-48 hours after surgery.Edema in the area of intervention may increase by the 3rd day. Some discomfort in the operated area can last up to 3-5 days. The severity of discomfort depends on your general health and vitality.

If you lead an active lifestyle, then there may be more discomfort in the postoperative period. It is better to rest for 7 to 10 days after the operation. To relieve pain, your doctor may prescribe pain relievers, also called analgesics. He may also prescribe medications to prevent the infection from developing.These drugs are called antibiotics.

NECESSARY

Tell your maxillofacial surgeon about any medication you are taking or about to take on the advice of friends and foes.
Follow the instructions for taking the prescribed medication.
If the pain persists or increases, tell your doctor.

DO NOT

Do not exceed the recommended dose of medication.
Do not drink alcohol after surgery and until you have finished taking your medications.
Do not drive a vehicle if you are taking narcotic analgesics.

Prevention of bleeding

Your doctor placed a gauze ball on the wound site to reduce bleeding until the blood clots. This ball should be bitten (not chewed) and left in the mouth for 30 minutes after surgery.

Slight bleeding from the sutured wound can continue for one to two hours after the operation.A small amount of blood may ooze from the wound within 24 hours. It should be borne in mind that even a small amount of blood stains saliva, which can create the appearance of significant bleeding (which is not true).

Important!

If more than four hours have passed since the intervention and the bleeding does not stop, contact your doctor. One day after the operation, you can brush your teeth without touching the surgical wound.

DO NOT

Do not rinse your mouth for 24 hours after surgery, even if there is an unpleasant taste due to blood or medication used.
Do not chew the gauze ball on the wound or use suction.
Physical activity is prohibited for 7 to 10 days after the operation.
Avoid drinking tea and coffee. It is better to eat chilled food. Hot food increases blood flow, which can cause bleeding.
Smoking and drinking alcohol are prohibited for two weeks after the operation. Failure to follow this recommendation can lead to increased bleeding at the surgical site, increases the likelihood of infection, and slows healing.

Prevention of edema

After the operation, edema may occur, which may increase within THREE days. After this time, the edema will begin to decrease and completely disappear in five to seven days. When the swelling begins to subside, a hematoma (bruise) may appear, which usually moves below the surgical site. The hematoma resolves within 10-14 days after surgery.

NECESSARY

Immediately after surgery, apply cold to the area of intervention.To do this, you can use frozen water, ice wrapped in a towel, frozen vegetables.
Ice is applied for 5 minutes, then a 30-minute break is taken, and so on for 12 hours after the operation.
If, after 72 hours after the operation, the swelling continues to increase or it does not decrease within 5 days, contact your doctor.

DO NOT

It is forbidden to apply heat to the operation area after the operation, massage the operation area, this will lead to a significant increase in edema.

Sinus lifting. Instructions for the patient.

Before surgery

For three days before surgery, rinse the mouth with 0.1% chlorhexidine solution 2 times a day for 2 minutes.
2-3 hours before the start of the operation, you must take the medication that your doctor prescribes. This is usually an antibiotic.
If you are worried, then the day before the operation, you can start taking drops of tincture of valerian, motherwort or valocordin.It should be remembered that these drugs reduce the reaction, therefore, within 24 hours after taking them, the precise mechanisms cannot be controlled.

After surgery

Do not eat or drink for two hours after surgery. Avoid hot food and hot drinks for 48 hours after surgery. Eat soft food before stitches are removed.
Do not spit out or displace the tampon applied to the intervention area for 30 minutes. Swallow saliva, not spit it out.
Apply ice to the intervention area.To do this, you can use a frozen water bottle, ice wrapped in a towel, frozen vegetables, meat, fish. Ice is applied through a napkin for 5 minutes at a 30-minute break. Ice is applied within 12 hours after surgery, usually until late in the evening on the day of surgery.
Please don’t blow your nose! Sneezing and coughing is allowed only with an open mouth! If the nasal mucosa dries up (this can happen in air-conditioned rooms), saline (saline) or boiled water can be instilled into the nasal passages.
Do not fly by air, do not travel by high-speed trains for 3 weeks.
It is forbidden to dive for a month.
It is forbidden to play sports for 2 weeks.

The following medications should be taken after surgery:

Rinse your mouth with 0.1% chlorhesidine solution after each meal until the stitches are removed.
After rinsing, apply to the area of the Metrogyl-Denta seams.
Take painkillers for 3 days according to the scheme below, then as needed

Ibuprofen 200 mg one tablet 4 times a day,

Ketanov 10 mg 3 times a day ( maximum 8 tablets per day),

3.Nimesil, taken orally, 1 sachet (100 mg of nimesulide) 2 times a day. The drug is recommended to be taken after meals. The contents of the sachet are poured into a glass and dissolved in about 100 ml of water. The prepared solution cannot be stored.

4. Vasoconstrictor drugs, antibiotic, antihistamines.

All pain medications are recommended to be taken after meals.

Memo for blepharoplasty

Memo for patients planning blepharoplasty

Dear ladies!

For a successful operation and the passage of the recovery postoperative period, we kindly ask you to remember and carefully follow the following recommendations.

Before your surgery:

Surgical correction of age-related changes in eyelid tissues (blepharochalasis) is performed in order to eliminate fatty hernias and excess skin in the form of skin folds in the upper and / or lower eyelids
The operation is performed under local anesthesia. The patient needs to undergo a clinical and laboratory examination and get the advice of a specialist (therapist, cardiologist, endocrinologist, allergist) about the absence of contraindications for surgery.If there are deviations in the results of clinical trials and contraindications for surgery, then surgical correction of blepharochalasis may be refused
Contraindications to surgery are progressive diseases of the organ of vision, chronic diseases in the stage of exacerbation or decompensation, bacterial and viral infections, diseases of the blood and some diseases of the endocrine system, pathology of the cardiovascular system, history of stroke, mental illness.If there is a cough, herpetic and pustular eruptions on the skin of the face, an increase in body temperature or menstruation, the operation should be postponed to another day. It is recommended to carry out the operation after 4 days after menstruation or 4 days before its start
On the eve of the operation, you must take a shower, wash your hair, do not apply cream on your face and do not apply makeup. It is recommended to eat 3 hours before surgery

Blepharoplasty and Botox: Be very careful when combining these eyelid lifting methods!

Immediately before plastic surgery, any cosmetic procedures are undesirable, since the doctor must see the natural state of the face.Plastic surgery of the eyelids after Botox can be done only in those cases when the effect of the drug has already ended. If, after Botox injections, the eyebrows did not rise, the plastic surgery of the eyelids is allowed to be done no earlier than after 14 days. After the end of rehabilitation, Botox is recommended as a supportive procedure.

After your operation:

Usually the recovery period lasts 2 weeks, then you can return to your usual lifestyle. Bed rest is shown only in the first hours after surgery
It is only worth focusing on not exposing the operated area to mechanical stress and not breaking the suture line, to prevent the risk of infection
After the operation, pain is practically not observed, however, if you feel rawness and soreness, you can take anesthetic (Ketanov, Nise)
You have been given a special medical adhesive plaster with white bandages, it must be carefully removed for 3 days.During the first two days, every hour during the waking period, it is recommended to apply cold or ice to the eyelids to relieve puffiness. Driving prohibited
Sleep exclusively on a high pillow or on 2-3 pillows, without tilting the head, so that the head rises above the level of the rest of the body (this position reduces swelling after blepharoplasty)
After removing the dressings, treat the sutures with an antiseptic aqueous solution of Chlorhexidine 2 times a day
Apply hydrocortisone ointment 0.5% ophthalmic and Lyoton gel (Sinyak-Off) 2 times a day to the skin of the eyelids, alternate (morning / evening)
Use moisturizing eye drops (Systane ultra plus) to prevent dry eyes
Do not wash your eyes.Do not rub your eyelids with your hands
Do not forget to visit the clinic again on the 6th day to remove the cosmetic suture
For 10 days, it is necessary to limit physical activity and sports (overexertion can lead to an increase in eye pressure and subsequent hemorrhage)
Refuse to visit baths, saunas, swimming pools and other places with high temperature and humidity
Do not take a hot shower or bath, carry out all hygiene procedures with warm water.Don’t wash your hair for 5 days. Avoid getting water on the eyelids
Don’t forget to wear sunglasses outside
Do not use eye makeup for 2 weeks. To mask hematomas, you can apply a foundation or Sinyak-Off ointment with a tonal effect
Do not wear contact lenses for 10 days, during this time it is recommended to switch to wearing glasses
Minimize eye strain by reading, watching TV, or working at a computer less often
Give up bad habits, alcohol, coffee or salty foods: all of these factors contribute to the development of puffiness
The procedures offered in beauty salons will help to significantly reduce the edema of the eyelids: bioptron, microcurrent, lymphatic drainage.Mesotherapy will make the scar completely invisible

Gymnastics

Helps to tone the muscles, increase blood supply and restore the functionality of the eyes. It is better to do it twice a day: in the morning and in the evening.

Basic exercises:

Focus on a point above, below, left and right
Raise your face up and blink continuously for 30 seconds
Close your eyes, then open your eyes and immediately focus on the farthest point in front of you
Circular movements of the eyes to the right-left
Tilt your head back and focus your gaze on the tip of the nose.Relax. Each exercise should be repeated 5-7 times, except for the second

Acupressure eyelid massage

Massage can be performed for 3 days, it will tone the eyelids!

Elements of acupressure lymphatic drainage massage of the eyelids, for applying cream:

1, 2, 3 points

in the area of the temple: with the second, third, fourth fingers of both hands, slide in a circular motion clockwise

4, 5, 6 points

along the edge of the lower eyelid: with the fourth finger, perform a light, point pressure movement, moving towards the inner corner of the eye

6 point

in the area of the inner corner of the eye: make 10 light pressure movements

7, 8 points

along the edge of the upper eyelid (under the eyebrow): with the third and fourth fingers, make a light, point pressure movement, moving towards the outer corner of the eye

Transconjunctival blepharoplasty will help get rid of bags under the eyes.The operation is effective, low-traumatic and short recovery period. Cold is applied only for the first 24 hours. It is recommended to instill eye drops “Combinil” (Tobradex) 1-2 drops 4 times a day for 10 days to prevent conjunctivitis. Ointment “Korneregel” for the lower eyelid for the speedy healing of the mucous membrane.

The effect of blepharoplasty lasts for 10 years, and this is a unique chance to prolong youth and beauty!

90,000 Recommendations after surgical procedures in the oral cavity

Extraction of a tooth, placement of an implant or any other surgical intervention in the oral cavity can complicate everyday life for some time.Here are some tips to help make this period more comfortable.

Pain Relief

Even if the local anesthesia has not yet departed, take an analgesic (paracetamol, ibuprofen, etc.) within half an hour after the completion of the operation, observing the dose and regimen recommended by the doctor. However, do not use these drugs on an empty stomach to avoid irritation of the mucous membranes.

Antibiotics

If your dentist has prescribed an antibacterial drug for you, start taking it on the same day the procedure was performed.To prevent indigestion, take the medication after meals and be sure to complete the course prescribed by your doctor.

Edema

Swelling, swelling and bruising in the surgical site may persist for 2-5 days after surgery. To alleviate the condition, for a couple of days, you can apply an ice pack or vegetables from the freezer wrapped in a towel to the swollen areas for 20 minutes, repeating the procedure every 2 hours. It is also recommended to sleep in a semi-raised state to reduce swelling (for example, with a high pillow under your head and back).

Difficulty moving the jaw

Difficulty opening the mouth with limited movement and pain in the mandibular joint may occur for several days after surgery. Do not forcefully open your mouth and work your jaw – this will only increase pain and slow down healing. Try to eat soft foods (porridge, soup, mashed potatoes) throughout the week.

Teeth sensitivity

Increased sensitivity of tooth enamel often persists for several weeks after surgical treatment.The use of special toothpastes and rinses marked sensitive will help reduce discomfort.

Cleaning

Good oral hygiene is very important in the postoperative period. Brush your teeth gently and use a soft bristled toothbrush. Avoid direct exposure to the affected area, but gradually work your way up to it every day. Use antiseptic fluids or salt water (1 teaspoon per glass of warm water) to rinse your mouth three times a day for 5 days after surgery.Do this carefully so as not to flush out blood clots that have formed on the wounds.

Seams

3-4 days after the operation, it is important to remove the stitches to avoid food stuck and infection. Most surgeons use self-absorbable sutures, but it is recommended that you visit your dentist afterwards to remove suture material and check the wound healing process. Check with your doctor about when to see you after your stitches.

Bleeding

A small amount of blood in the saliva for a few days after surgery is normal. However, if the bleeding from the wound is severe, it is best to stop the bleeding by placing a damp cotton swab on the affected area for 10 minutes.

Food

Eat only soft food until the “freeze” is gone, and after the implant is installed, follow a similar diet for 2 weeks. Try not to chew on the affected side.

Exercise and sports

It is best to avoid strenuous activity for several days after surgery. If you exercise regularly and professionally, then before the operation, you should discuss with the surgeon when you can return to intense physical activity.

Additional tips

Do not touch the wound with your tongue, fingers, or any object that could damage tissue.

Numbing medicine for stitches: Lidocaine injection Uses, Side Effects & Warnings

Pain management for children needing laceration repair

Abstract

Infiltrative anesthesia: lidocaine and bupivacaine

Administering local anesthesia: pain-reduction techniques

Needle-free local anesthesia

Lidocaine-adrenaline-tetracaine gel.

Amethocaine and tetracaine gels.

Lidocaine-prilocaine combination.

Conclusion

Notes

Footnotes

References

Pain management for children needing laceration repair

Abstract

Infiltrative anesthesia: lidocaine and bupivacaine

Administering local anesthesia: pain-reduction techniques

Needle-free local anesthesia

Lidocaine-adrenaline-tetracaine gel.

Amethocaine and tetracaine gels.

Lidocaine-prilocaine combination.

Conclusion

Notes

Footnotes

References

Stitches (Sutures): Purpose, Procedure, Recovery

Signs a Cut May Need Stitches

The Procedure

Caring for Stitches

Removal of Stitches

Other Options

ProcGuide: Suturing

Go to the Ethicon suturing manual and this knot tying manual for more references.

ANESTHESIA

TECHNIQUE FOR WOUND ANESTHESIA

WOUND CLEANSING

Wound Cleansing Agents:

Irrigation:

Cleansing setup and procedure:

INSTRUMENTS AND SUTURE MATERIAL

Instruments:

Suture Materials:

Nonabsorbable Material:

Absorbable Material:

Suggested Guidelines for Suture Material and Size for Body Region:

ALTERNATIVE CLOSURES

RECOMMENDED INTERVALS FOR REMOVAL OF SKIN SUTURES:

WOUND AFTERCARE

Pain Control After Surgery: Symptoms, Treatment

Why is pain control after surgery so important?

What kinds of pain will I feel after surgery?

What can I do to help keep my pain under control?

Who is going to help manage my pain?

What are the types of pain-control treatments?

What are some of the risks and benefits associated with pain medication?

Are there ways I can relieve pain without medication?

How can I control pain at home?

How do I play an active role in my pain control?

Skin Glue vs Stitches | Healing Your Child’s Wound

Skin Glue

Wounds that Require Stitches

Easing the Pain and Anxiety

Minimizing Scars

Which Does My Child Need?

Treatment of pain associated with operations

What is acute postoperative pain?

Why treat acute postoperative pain?

How is the intensity of pain assessed?

How to treat pain after surgery?

Groups of painkillers

New technology of pain relief after cesarean section

Federal Center for Cardiovascular Surgery (Khabarovsk)

Recommendations after surgery – Arte dental clinic dental clinic

Memo for blepharoplasty

Memo for patients planning blepharoplasty

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