Pdf pain mx ard-ksharasutra-dr mahesh 18 aug2020
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Pain management of Anorectal disorders ARD Ksharasutra Ksharsutra therapy Anorectal disorders are piles, fistula etc Post therapy care especially pain management Dr Mahesh Kumar 18 aug2020
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Pdf pain mx ard-ksharasutra-dr mahesh 18 aug2020
- 1. 1 Dr Mahesh Kumar M,S, (Ay)-BHU Assistant Professor Department of Shalya Tantra CBPACS Khera Dabar New Delhi Pain management after ksharasutra therapy in Anorectal Diseases (ARD)
- 2. What are Anorectal Disorders (ARD) ? 2 The anorectal disorders are the diseases pertaining to anus & rectum. Common ARD – Bhagandara, Arsha, Parikartika, Gudabhramsha Cancer
- 4. What is ksharasutra therapy? The ksharasutra are Ayurvedic medicated thread used for treatment of many anorectal diseases.
- 5. 5 POST OPERATIVE CARE INVOLVES Assessment . Diagnosis Planning. . Intervention . Outcome evaluation
- 6. Common complain in Post operative •Pain Excess Gas formation • Bleeding Fecolith/hard stool •Irregular bowel habit Infection 6
- 7. Causes of Pain in ARD Fissure in ano – acute chronic Anorectal abscess Fistula in ano Pile/ haemorrhoid Thrombosed pile mass Haematoma Proctitis IBD Severe Pruritus ani CA rectum, CA prostate Fecolith Constipation/obstipaion Foreign body in anal canal – gudgata shalya Anal stricture Anal stenosis Solitary rectal ulcer Anal canal fibrosis/ keratinised Anal warts Pelvic descent syndrome 7
- 8. Causes of pain in post operative cases of ARD Improper PR exam After instrumentation/proctoscopy Probing – wrong probing , without lubricant Excess tightening of KS - in post op Application of multiple KS in FIA, multiple KS ligation of pile 8
- 9. Causes of pain ………………………contd No/Improper drainage of pus/secretion in FIA and Anorectal absces Sign of false healing and hyper granulation tissue presence Development of haematome in pile ligation Presence of stitch in skin while closing the wound 9
- 10. Cont............ Big wound /ulcer/ big pocket/cavity Local pressure = pressure causes irritation of local perianal area and pain Presence of Hairs – uncleaniness excess hair causes rub, provide site of infection Infection – involvement of bacteria in wound , faecal matter 10
- 11. Cont............ To tight packing Ksharavarti packing in healthy wound condition causes irritation and pain Lesser tolerance of pain in patient – quesy patient, consider the thing then adopt the procedure 11
- 12. Cont............ Not removal of packing / flatus tube/ bandage C & D from anus Excess secretion from wound= repeated soakage, itching, pain 12
- 13. Pain Management - methods Educate the patient about procedure Local hygiene – cleaniness , hot sitz bath with sphatika, tankan powd Avoid excess sitting in toilet/ straining Diet – Avoid spicy diet take plenty of fluid milk with MUNAKKA, Anjeer papeeta, fibrous diet 13
- 14. Pain Mx……contd Anti inflammatory/analgesic = sigru guggulu, triphala guggulu Antibiotic if needed Lignocaine spray 10% Lignocaine jelly 2% 14
- 15. Cont........... Antacid – if needed Bowel care – virechak Matrabasti C & D daily Gentle Care of wound 15
- 16. Cont........... Manual anal dilatation Ksharasutra change – gently Make proper draining of discharge/secretion 16
- 17. Conclusion Pain is common complain of post op. Its management is essential. The result of main action depends on post operative care 17
- 18. THANK YOU 18