The aim of this randomized controlled study was to compare ultrasound-guided procedure with the Seldinger's technique for placement of implantable venous ports. A total of 214 patients were randomized to receive TIAP placement by either ultrasound-guided procedure or the Seldinger's technique. Complications and pain perception were compared between these two groups. No severe perioperative or periinterventional complication occurred. Significantly (P < 0.05) lower pain perception was observed in the ultrasound-guided group. Seldinger's technique group showed higher rate in incidence of early and late complications including catheter dislocation, catheter occlusion, venous thrombosis, fever of unknown origin, skin necrosis, and sepsis. In conclusion, both techniques, the TIAP implantation via ultrasound-guided jugular vein puncture and via Seldinger's technique subclavian vein puncture, are feasible and safe. Regarding intrainterventional pain perception and implantation-related complications, the jugular vein puncture under ultrasound guidance seems to be advantageous.

The purpose of this study was to investigate the incidence and risk factors of infections associated with totally implantable venous-access ports (TIVAPs) in our hospital. From April 2007 through November 2013, a total of 1,026 patients with TIVAP were included in this study. We retrospectively analyzed the incidence of port-related infection, patient characteristics, and history. Risk factors for IVAP-related infection were determined statistically. Overall, 97 (9.59 %) of 1,026 infectious cases were reported. By reviewing the medical record of the patients, we found that younger age, hematogenous malignancy, and palliative chemotherapy were associated with higher infection incidence rate in patients who had implanted TIVAP (P < 0.05) in the subgroup analysis. In contrast, gender and insertion site were irrelevant factors in predicting the infection risk. Overall, TIVAP were proved to be safe and effective. Younger age, hematogenous malignancy, and palliative chemotherapy were associated with higher infection in patients who had implanted TIVAP.

BackgroundAlthough pre-emptive analgesia is commonly used for the management of postoperative pain in developed countries, no defined protocol has been carried out and widely practiced, especially in transabdominal hysterectomy. Keeping this in mind the present study aimed to investigate the effects of multimodal pre-emptive analgesia on pain management, stress response and inflammatory factors of patients undergoing transabdominal hysterectomy to find an optimized way of pre-emptive analgesia.MethodsOne hundred patients undergoing abdominal hysterectomy were randomly divided into four groups (Trial registration: ChiCTR-IPR-15005848). Group P1 was given intravenous flurbiprofen and epidural fentanyl + ketamine before surgery; Group P2 received intravenous flurbiprofen before surgery and epidural fentanyl + ketamine after surgery; Group P3 was given epidural fentanyl + ketamine before surgery and intravenous flurbiprofen after surgery; Patients in Group C received normal saline treatment.ResultsCompared with control group, the first time to request additional analgesics after surgery were significantly later (P <0.05), 24 h dosage of analgesia were significantly less (P <0.05), VAS score at all time periods after surgery were significantly lower (P <0.05) in Group P1, P2, or P3. At 12 h or 24 h after surgery, VAS score in Group P1 was significantly lower than that in group P2 or P3 (P <0.05, P <0.05). No significant adverse effects were found among the groups (P > 0.05). At 1 or 2 days after surgery, the levels of cortisol, glucose, and IL-6, TNF-α in group P1, P2, and P3 were significantly lower than those in group C (P < 0.05); while, the levels in group P2, P3 were significantly lower than those in group P1 (P < 0.05).ConclusionMultimodal pre-emptive analgesia could significantly lower VAS score, inhibit stress response, and reduce inflammatory response in patients undergoing transabdominal hysterectomy, which can be a rational strategy for pain control in future.Trial registrationChiCTR-IPR-15005848 on January 17, 2015.