Iris Hospital

The word 'surgery' is often dreaded by most patients. Be it an invasive oral surgery or a keyhole gallbladder surgery, it does not evoke a ready 'yes' in most patients. There are too many patients who are ready to be on long-term medications if they could to avoid the surgery and its complications. While there could be swelling, bruising, tingling and many other symptoms, the one feared by most is the postoperative pain. What happens after the effect of the anesthetic wears off can leave many patients in a very anxious and fearful state. The trick is to prepare oneself not just for the surgery but for the after effects.

Before the surgery, a detailed discussion with the doctor on the following is very important:

1. List of medications: Complete list of medications include supplements so that the medications used during and after surgery to avoid any potential drug interactions
2. Type and severity of the pain: This will help you anticipate and be prepared for the pain after the surgery.
3. Pain tolerance/threshold: Letting your doctor know your tolerance levels can help them prescribe an appropriate pain killer 

After the surgery, the following are some ways to cope with the pain:

1. Pain killers - Don't wait for the anesthesia effect to completely wear out. Take the painkiller much before the pain starts so that the onset of pain is delayed or nullified.  For severe cases, opioids may be used to manage immediate postoperative pain.  However, in most cases, non-steroidal anti-inflammatories like ibuprofen are used. They may also be used up to a few days after surgery to ease the pain and inflammation, depending on the type of surgery.
2. Topical creams/lotions - In cases involving skin incisions, these help reduce the pain in the skin along the incision.
3. Compression stockings - In addition to reducing blood clot, they also reduce pain in the legs.
4. Physiotherapy - If there is a joint involved, doing physiotherapy after surgery is extremely beneficial. In addition to reducing pain, they also help improve mobility.
5. Sleep - Sufficient sleep (more than you normally would) promotes healing and helps your ability to cope with the pain.
6. Heating pads and ice packs - If these are your regular remedies for pain, feel free to use them even in postsurgical pains.
7. Reduce Stress - This will help you cope better with the pain and heal faster.

A given patient and a given surgery are a unique combination. No two patients will react the same way to a particular surgery. Postsurgical pain can be managed very effectively with a little planning.

An inflammation of the pancreas is known as pancreatitis. The pancreas is an organ that produces digestive enzymes. Pancreatitis might start any day and continue for long period and it requires immediate medical attention. It is of two types- acute pancreatitis and chronic pancreatitis. Although the treatment usually requires hospitalization, pancreatitis can be easily stabilized and the underlying cause can be treated thereafter.

Pain in pancreatitis typically radiates towards back as well apart from producing pain in abdomen. Acute pancreatitis may be of two types-

1. Mild acute pancreatitis- It usually resolves with conservative management after hospitalisation. 
2. Severe acute pancreatitis- This type of pancreatitis is associated with organ failure. This type is life threatening and needs treatment at critical care unit.

Pancreatitis may be caused due to various reasons:

1. Gall bladder stone: The pancreatic duct lies next to the bile duct. The gallstones enter the small intestine after passing through the common bile duct. Often the stones that remain in the common bile duct have a negative effect on the pancreas, which causes a hindrance to the normal flow of the pancreatic fluids, causing pancreatitis. Also a back flow of the bile into the pancreas can cause pancreatitis. 
2. Alcohol: Long time alcohol use also causes pancreatitis. Alcohol can damage the pancreas tremendously causing it to get inflamed.
3. Other causes: Hereditary disorders in the pancreas, cystic fibrosis, high level of triglycerides, and a few medicines may also cause pancreatitis.

Symptoms: 

1. The first symptom of pancreatitis is abdominal pain: The pain may be sudden or gradually increasing, but is usually aggravated after eating. It is severe and constant, and may continue for a few days. If you are suffering from pancreatitis, you will feel very sick after a sudden attack and you might require medical assistance immediately.
2. Swollen abdomen: Pancreatitis my cause your abdominal area to swell up and become tender.
3. Nausea: If your abdomen suddenly starts paining due to the onset of pancreatitis, you tend to feel extremely nauseous. You might end up vomiting and may also have violent heaves.
4. Fever: The inflammation will cause you to run a temperature, along with a searing pain in your stomach, which will make you feel extremely uncomfortable.
5. Rapid pulse: Pancreatitis affects the rate at which the heart beats, causing a rapid increase in the pulse rate.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Any surgical procedure requires the creation of a wound and then a subsequent closure by the repositioning and securing the surgical flaps by suturing to allow optimum healing. A suture is a strand or thread used for the approximation of tissues and also for ligation off blood vessels. Suturing is the act of sewing or bringing tissues or the flap edges together and holding them in apposition until normal tissue healing takes place. Placement of sutures helps the wound to withstand normal functional stresses and to resist opening of the wounds.

Suturing techniques:

1. Interrupted Suture-Sling Suture - The suture is passed through both the edges at an equal depth and distance from the incision, needle penetration should be 3mm from wound edges and the knot is tied. It is the most commonly used suture. Advantages of this technique are as follow
   • It is strong and can be used in areas of stress.
   • Successive sutures can be placed according to individual requirement
   • Each suture is placed independently and the loosening of one suture will not produce any loosening of the other.
   • A degree of eversion can be controlled.
   • If the wound becomes contaminated, infected or if there is a formation of hematoma, removal of a few sutures is possible that and provides a satisfactory treatment.
2. Continuous over and over suture - A simple interrupted suture is placed first and the needle is then reinserted in a continuous manner in such a way that the suture passes perpendicular to the incision line below and obliquely below. The suture is ended by passing a knot over the untightened end of the suture. It provides a rapid technique for closure and distributes the tension equally over the suture line.
3. Continuous locking suture - In this technique, locking is provided by withdrawing the suture through its own loop. The suture passes perpendicular to the incision line. The locking prevents excessive tightening of the suture as the wound closure progresses.
4. Mattress suture - These sutures can be horizontal or vertical. These are used for resisting a muscle pull, evert the wound edges and to adapt the tissue flaps tightly to the underlying structures.
   • The horizontal mattress suture gives a broad contact of the wound margins. In this suture, the needle is passed from one edge of the incision to another and then again from the latter edge to the first edge in a horizontal manner, after which a knot is tied. The distance of the needle penetration from incision line and the depth of needle penetration is the same for each entry point, but the horizontal distance of the points of penetration on the same side of the flap differs.
   • The vertical mattress suture is similar to the horizontal mattress, except that, all the factors remaining constant, the penetration depth varies. It is used for the closure of deep wounds.
5. Figure of eight suture - The figure of eight suture can be used for the closure of small gaping wounds like an extraction suture closure after removal of a tooth.
6. Subcuticular suture - The subcuticular layer of the tough connective tissue if sutured will aid in holding together skin edges in a close approximation when better cosmetic results are desired. Continuous short lateral stitches are taken beneath the epithelial layer of the skin. The ends of the suture come out at each end of the incision and are knotted together. This type of suturing leaves back a cosmetic scar.

Some common types of surgical knot tying used during a surgical procedure are

1. Square knot - It is also known as the standard knot or the Reef knot method. It is a special knotting technique in which the knots are securely tied. Four throws of the suture material are placed in position and the ends are cut long.

2. Surgeon’s knot - It is formed by two throws of the suture around the needle holder on the first tie and one throw in the opposite direction in the second tie.

3. Granny’s knot - It is also called as the slip knot technique. It is used when using silk, chromic catgut or the plain catgut suture material. It involves a tie in one direction followed by a second tie in the same direction and a third tie in the opposite direction to square the knot and hold it securely.

In case you have a concern or query you can always consult an expert & get answers to your questions!