Nā lāʻau no ke kuapo kuli

Anter

• Anesthesia i ke kahakaha ʻana
• Ka mālama ʻana i ka ʻeha
• Nā lāʻau ʻeha waha
• Nā pumps analgesia (PCA) e kaohi maʻi ʻia
• Nā poloka nerve
• Liposomal bupivacaine
• Ka pale ʻana i nā pehu koko
• Kāohi i ka maʻi
• Nā lāʻau ʻē aʻe
• Lawe aku

I ka wā o ke kuli holoʻokoʻa, e hoʻopau kahi kauka i nā mea i hōʻino ʻia a hoʻokomo i kahi hui kuli ʻimi.

Hiki i ke kīʻaha ke hōʻemi i ka ʻeha a hoʻonui i ka neʻe i ka wā lōʻihi, akā e loaʻa koke ka ʻeha ma hope o ke kaʻina hana a i ka wā o ka hoʻōla.

Manaʻo pinepine ka poʻe ma hope o 6 mau mahina a hoʻokahi makahiki.I kēia manawa, hiki i ka lāʻau ke kōkua iā lākou e mālama i ka ʻeha.

Anesthesia i ke kahakaha ʻana

ʻO ka hapa nui o ka poʻe i ka ʻoki pani pani ma lalo o kahi anesthetic maʻamau.

Eia nō naʻe, mai ka manawa a lākou e ala ai, pono lākou i ka ʻeha a me nā ʻano lāʻau ʻē aʻe e kōkua iā lākou e mālama i ka pilikia a hōʻemi i ka pilikia o nā pilikia.

Hiki i nā lāʻau lapaʻau ma hope o ke kīpoki pani kuli ke kōkua iā ʻoe:

• hoʻēmi i ka ʻeha
• hoʻomalu nausea
• pale aku i nā huehue koko
• hoʻohaʻahaʻa i nā pilikia o kahi maʻi

Me ka lapaʻau kūpono a me ka hoʻōla kino, nui ka poʻe e hoʻi hou mai kahi pani kuli a hiki ke hoʻi i kā lākou hana i kēlā me kēia lā i loko o nā pule.

Ka mālama ʻana i ka ʻeha

Me ka lawa ʻole o ka mālama ʻeha, loaʻa paha iā ʻoe ka paʻakikī e hoʻomaka i ka hoʻoponopono hou ʻana a me ka neʻe ʻana ma hope o ke kaha ʻana.

He mea nui ka hoʻoponopono a me ka neʻe no ka mea hoʻomaikaʻi lākou i nā manawa o kahi hopena maikaʻi.

Koho paha kāu kauka lāʻau mai nā koho like ʻole, e like me:

• opioids
• poloka aʻaola ākea
• acetaminophen
• gabapentin / pregabalin
• anti-inflammatories non-steroidal (NSAIDs)
• Nā mea pāpā COX-2
• ketamine

E ʻike i nā mea hou aʻe e pili ana i ka lāʻau ʻeha no ka huina o ke kuli.

Nā lāʻau ʻeha waha

Hiki i nā Opioids ke hoʻokuʻu i ka ʻeha kaulike a ʻeha loa. Kauoha pinepine kahi kauka iā lākou ma kahi o nā koho ʻē aʻe.

ʻO nā laʻana me:

• morphine
• hydromorphone (Dilaudid)
• hydrocodone, aia ma Norco a me Vicodin
• ʻoxycodone, aia i Percocet
• meperidine (Demerol)

Eia nō naʻe, hiki i ka lawe ʻana i nā lāʻau opioid he nui loa ke kumu:

• kōpaʻa
• hiamoe
• nausea
• hanu lohi
• huikau
• he poho o ke kaulike
• he ala hele wāwae ʻole

Hiki iā lākou ke hoʻonāukiuki. No kēia kumu, ʻaʻole e kuhikuhi kahi kauka i nā lāʻau opioid no ka lōʻihi ma mua o kāu e pono ai.

Nā pumps analgesia (PCA) e kaohi maʻi ʻia

ʻO nā pumps-control patient (PCA) ka mea maʻamau i nā lāʻau ʻeha opioid. E ʻae kēia mīkini iā ​​ʻoe e kaohi i ka mahele lāʻau o kāu lāʻau.

Ke paʻi ʻoe i ka pihi, hoʻokuʻu ka mīkini i nā lāʻau hou aʻe.

Eia nō naʻe, kaohi ka pauma i ka lāʻau ma o ka manawa. Polokalamu ʻia no laila ʻaʻole hiki ke lawe i kahi mea nui loa. ʻO kēia ʻaʻole hiki iā ʻoe ke loaʻa ma mua o kahi nui o nā lāʻau i kēlā me kēia hola.

Nā poloka nerve

Lawe ʻia kahi poloka nerve ma ka hoʻokomo ʻana i kahi catheter intravenous (IV) i nā wahi o ke kino e kokoke ana i nā aʻalolo e lawe i nā leka ʻeha i ka lolo.

ʻIʻike ʻia kēia ma ke ʻano he anesthesia āpana.

ʻO nā poloka nerve kahi ʻokoʻa i nā pumps PCA. Ma hope o hoʻokahi a ʻelua mau lā, e kāʻili kāu kauka i ka catheter, a hiki iā ʻoe ke hoʻomaka i ka lawe ʻana i nā lāʻau ʻeha me ka waha inā makemake ʻoe iā lākou.

ʻO ka poʻe i loaʻa nā poloka nerve i loaʻa ka hauʻoli kiʻekiʻe a me nā hanana kūʻē liʻiliʻi ma mua o ka poʻe i hoʻohana i ka pauma PCA.

Eia nō naʻe, hiki i nā poloka nerve ke hoʻokau i kekahi mau mea ʻino.

Pākuʻi ʻia lākou:

• maʻi maʻi
• kahi hopena maʻi ʻaʻano
• kahe ana ke koko

Hiki i ke aʻalolo nerve ke hoʻopili i nā mākala i ka wāwae haʻahaʻa. Hiki paha i kēia ke hoʻolohi i kāu hoʻōla kino a me kou hiki ke hele.

Liposomal bupivacaine

ʻO kēia kahi lāʻau hou no ka hōʻoluʻolu ʻeha a ke kauka i hōʻomo ai i ka pūnaewele ʻoki kino.

ʻIke ʻia hoʻi ʻo Exparel, hoʻokuʻu i kahi analgesic mau e hoʻomaha i ka ʻeha a hiki i 72 mau hola ma hope o kāu kaʻina hana.

Kauoha paha ke kauka i kēia lāʻau me nā lāʻau ʻeha ʻē aʻe.

Ka pale ʻana i nā pehu koko

Ma hope o ke kuhi o ke kuli, aia kahi pilikia o ka hoʻomōhala ʻana i kahi hāpule koko. ʻO kahi ʻōpala i loko o nā kīʻaha koko hohonu i kapa ʻia ʻo deep vein thrombosis (DVT). Kū pinepine lākou i ka wāwae.

Eia nō naʻe, hiki i kahi ʻōpala ke haki i kekahi manawa a hele a puni ke kino. Inā hiki i nā māmā, hiki ke hopena i ka embolism pulmonary. Inā hiki i ka lolo, hiki iā ia ke alakaʻi i ka maʻi hahau. ʻO kēia nā pilikia weliweli e ola nei.

Aia kekahi pilikia kiʻekiʻe o ka DVT ma hope o ke kaha ʻana no ka mea:

• Hoʻokuʻu kou mau iwi a me nāʻiʻo i nā protein i kōkua i ka hoʻopili ʻana i ka wā o ke ʻoki.
• Hiki i ka neʻe ʻole i ke kīpē ke hōʻemi i ke kahe o ke koko, hoʻonui i ka manawa e ulu ai kahi ʻōpala.
• ʻAʻole hiki iā ʻoe ke neʻe a puni no kekahi manawa ma hope o ke kaha ʻana.

E kauoha aku kāu kauka i nā lāʻau a me nā ʻenehana e hōʻemi i ka makaʻu o ke kahe koko ma hope o ke kahakaha ʻana.

Hiki i kēia ke hoʻopili:

• compression stockings, e kau ma kāu mau bipi keiki a i ʻole nā ​​ʻūhā
• hāmeʻa hoʻoliʻiliʻi kaʻina, kahi e kaomi mālie i kou mau wāwae e hāpai i ka hoʻi ʻana o ke koko
• aspirin, he mea hōʻoluʻolu ʻāʻī over-the-counter nāna e mānoanoa i kou koko
• haʻahaʻa-molekoki-kaupaona heparin, a hiki iā ʻoe ke loaʻa ma ke kīkī ʻana a i ʻole ma o ka hoʻokomo IV mau loa
• nā lāʻau lapaʻau anticlotting i hoʻopili ʻia, e like me fondaparinux (Arixtra) a i ʻole enoxaparin (Lovenox)
• nā lāʻau lapaʻau ʻē aʻe e like me warfarin (Coumadin) a me rivaroxaban (Xarelto)

E hilinaʻi nā koho i kāu mōʻaukala olakino, e pili ana i nā maʻi āpau, a inā he makaʻu paha kou i ke kahe ʻana.

ʻO ka hana ʻana i nā moena ma ka moena a me ka neʻe ʻana e like me ka hiki ke hiki ma hope o ke kuli ʻana o ke kuli hiki ke kōkua i ke pale ʻana i ke koko a hoʻonui i kou ola.

ʻO ke kuʻi koko kekahi kumu e hana ai nā pilikia ma hope o ke kuli o ke kuli. E ʻike hou aʻe e pili ana i nā pilikia ʻē aʻe e hiki ai.

Kāohi i ka maʻi

ʻO ka maʻi ka maʻi kūpilikiʻi ʻē aʻe e hiki ke ala aʻe i ka wā o ke kahakaha pani kuli.

I ka wā ma mua, a puni ka poʻe i hoʻomohala i kahi maʻi, akā ʻo ka helu o kēia manawa ma kahi o 1.1 pākēneka. Hāʻawi kēia i nā lāʻau lapaʻau i kēia manawa i nā antibiotic ma mua o ke kaha ʻana, a hoʻomau paha lākou e hāʻawi iā lākou no 24 mau hola ma hope.

ʻO ka poʻe me ka maʻi diabetes, ka momona, nā pilikia kahe, a me nā kūlana e hoʻopili i ka ʻōnaehana pale, e like me ka HIV, ʻoi aku ka nui o ka pilikia o ka maʻi.

Inā ulu kahi maʻi, e kauoha ke kauka i kahi papa antibiotic ʻē aʻe.

Inā kū kēia, pono ia e lawe i ka papa holoʻokoʻa o ka lapaʻau, ʻoiai inā ʻoe e ʻoi aku ka maikaʻi. Inā kū ʻoe i kahi papa o nā antibiotic ma waena, hoʻi paha ka maʻi.

Nā lāʻau ʻē aʻe

Ma waho aʻe o nā lāʻau e hōʻemi i ka ʻeha a me nā pilikia o ke kahe o ke koko ma hope o ke kuli, hiki i kāu kauka ke kuhikuhi i nā lāʻau ʻē aʻe e hōʻemi i nā hopena o ka anesthesia a me nā lāʻau ʻeha.

I hoʻokahi noiʻi, ma kahi o 55 pākēneka o ka poʻe e pono ai ka mālama ʻana no ka nausea, ka luaʻi ʻana, a i ʻole ka constipation ma hope o ke kaha ʻana.

ʻO nā lāʻau antinausea pū kekahi:

• ondansetron (Zofran)
• promethazine (Phenergan)

Kau kauka paha i kau kauka no ka ʻōpala a i ʻole nā ​​pahee palupalu, e like me:

• palapala sodium (Colace)
• bisacodyl (Dulcolax)
• polyethylene glycol (MiraLAX)

Hiki paha iā ʻoe ke loaʻa nā lāʻau hou aʻe inā makemake ʻoe iā lākou. Hiki i kēia ke hoʻopili i kahi patch nikotina inā ʻoe e puhi.

Lawe aku

Hiki i ke kīʻaha pani kuli ke hoʻonui i ka ʻeha no kekahi manawa, akā hiki i ke kaʻina hana ke hoʻomaikaʻi i ka pae o ka ʻeha a me ka neʻe i ka wā lōʻihi.

Hiki i nā lāʻau ke kōkua i ka ʻeha ʻana i ka liʻiliʻi, a hiki i kēia ke hoʻomaikaʻi i kāu neʻe ma hope o ke kahakaha ʻana.

Inā ʻike ʻoe i kekahi ʻōuli a i ʻole nā ​​hopena maikaʻi ʻole ma hope o ka hoʻololi ʻana o ke kuli, ʻoi aku ka maikaʻi e kamaʻilio me ke kauka. Hiki iā lākou ke hoʻoponopono pinepine i kahi lāʻau a hoʻololi paha i ka lāʻau.