Reduced Laparoscopic Intra-abdominal Pressure During Laparoscopic Cholecystectomy and Its Effect on Post-operative Pain: a Double-Blinded Randomised Control Trial

Abstract Background Pain after laparoscopic cholecystectomy remains a challenging issue to this relatively less invasive surgery, In this study we try to tackle this problem through intraperitoneal injection of drugs particularly morphine and bupivicaine to reduce post-operative pain. Objectives The Aim of this study is to assess postoperative pain in laparoscopic cholecystectomy by comparing between administering intraperitoneal bupivacaine alone versus intraperitoneal bupivacaine with intravenous morphine; Using the VAS scale and measuring time for rescue analgesic administration. Methods and material This prospective double blinded randomized clinical trial study was conducted in Ain Shams University hospital after approval of the anesthesia department and the local ethics and research committee over 6 months and after obtaining a written informed consent. Sixty patients underwent laparoscopic cholecystectomy were included in the study their ages range between 18 and 60 years old and classified as ASA I and II. The patients were randomly divided using computer generated randomization into two groups 30 patients in each (n = 30), Group BM received 30 ml of mixture of bupivacaine and 2 mg morphine while group BO received bupivacaine only Results This study showed that Morphine bupivacaine admixture had made dramatic decline in shoulder and abdominal pain VAS scores specifically at the 18th and24th hour; 15 patients in the BM group had either VAS score zero or 1 when compared to BO group whom their scores at the 18th and 24th hour was between 4 and 8. Also, there was more decrease in postoperative analgesic consumption in BM group. Conclusions We conclude that intraperitoneal instillation of 2 mg to bupivacaine 0.5% in elective LC significantly reduced post-operative shoulder pain and analgesic requirement when compared to bupivacaine 0.5% alone.

Download Full-text

Laparoscopic Intra-abdominal Pressure Study: A Double Blinded Randomised Control Trial

HPB ◽

10.1016/j.hpb.2020.11.223 ◽

2021 ◽

Vol 23 ◽

pp. S94

Author(s):

E. Gin ◽

D. Lowen ◽

M. Tacey ◽

R. Hodgson

Keyword(s):

Randomised Control Trial ◽

Abdominal Pressure ◽

Double Blinded

Download Full-text

600 The Use of a Wide-Awake Local Anaesthesia No Tourniquet (WALANT) Technique in Foot and Ankle Procedures - A Randomised Control Trial

British Journal of Surgery ◽

10.1093/bjs/znab134.456 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

T M Borg ◽

M Tahir ◽

N Heidari

Keyword(s):

Spinal Anaesthesia ◽

Local Anaesthesia ◽

Randomised Control Trial ◽

P Value ◽

Foot And Ankle ◽

Post Procedure ◽

Trimalleolar Fractures ◽

Post Operative Pain ◽

Wide Awake ◽

No Tourniquet

Abstract Introduction Wide awake local anaesthesia no tourniquet (WALANT) is a widely used technique in upper limb procedures that has gained increasing popularity during the coronavirus pandemic. The benefit of WALANT for foot and ankle surgeries is less clear, especially in patients with multiple comorbities. The primary aim of this study was to compare post-operative pain levels in patients undergoing ankle fracture fixation. Secondary objectives included comparison of intra-operative patient experiences, clinical outcomes, and patient satisfaction 1-year post-procedure. Method 129 patients presenting with ankle fractures were enrolled in a multicenter randomised control trial from February 2016 to January 2020. Patients with medial malleolar, lateral malleolar, bimalleolar or trimalleolar fractures received either WALANT (62 patients) or spinal anaesthesia (67 patients). A 5ml solution of 0.9% saline and 2% lidocaine with 1: 100,000 adrenaline was used for WALANT. Results Compared to patients who received spinal anaesthesia, those in the WALANT group experienced less post-operative discomfort and were more satisfied 1-year post-procedure (p-value = 0.003). Surgical outcomes were similar for both groups. Cost analysis revealed that WALANT is significantly more economical. Conclusions WALANT is an effective and safe anaesthetic for foot and ankle procedures. Without use of a tourniquet, it reduces post-operative pain and so, eases patient recovery.

Download Full-text

Comparative Evaluation of Effectiveness of Intravenous Paracetamol and Intravenous Diclofenac as Post-operative Analgesia in Laparoscopic Cholecystectomy

Journal of Lumbini Medical College ◽

10.22502/jlmc.v6i2.248 ◽

2018 ◽

Vol 6 (2) ◽

pp. 6

Author(s):

Kalpana Kharbuja ◽

Mahesh Sharma ◽

Nil Raj Sharma

Keyword(s):

Laparoscopic Cholecystectomy ◽

Visual Analogue Scale ◽

Analogue Scale ◽

P Value ◽

Anesthesia Induction ◽

Chi Square ◽

Rescue Analgesia ◽

Post Operative Period ◽

Post Operative Pain ◽

Intravenous Paracetamol

Introduction: Though the development of minimally invasive surgery has revolutionized the field of surgery, post-operative pain is still a significant issue. Unlike in the past, concerns about adverse effects have limited the role of opioids in post-operative pain management. This study aims to compare the effectiveness of intravenous paracetamol and diclofenac as postoperative analgesia in laparoscopic cholecystectomy. Methods:One hundred and twenty eight patients of American Society of Anesthesiologists (ASA) categories I and II included in this study were divided into two groups. Anesthesia induction and maintenance were standardized. The first group received 15mg/kg (maximum 1gm) intravenous paracetamol and the second group received 2mg/kg (maximum 75mg) intravenous diclofenac 30 minutes prior to ending of surgery. A questionnaire was responded by patients and chart was maintained by visual analogue scale. Mann Whitney U test was used to analyze quantitative data and Chi-square test for categorical data. P value <0.05 was considered statistically significant. Results: Profiles of hemodynamic changes were almost similar in both groups with respect to heart rate and blood pressure. However, paracetamol infusion provided hemodynamic stability in post-operative period. We observed statistically significant differences in visual analogue scale between the two groups. Most of the patients in paracetamol group had low mean pain scores in post-operative period and provided an extended analgesia compared to diclofenac. No serious postoperative complication was observed in paracetamol group. Conclusion: Administration of intravenous paracetamol has better and prolonged analgesic effect with low mean pain score and less requirement for rescue analgesia compared to diclofenac.

Download Full-text

LAPAROSCOPIC CHOLECYSTECTOMY;

The Professional Medical Journal ◽

10.29309/tpmj/2013.20.05.1513 ◽

2013 ◽

Vol 20 (05) ◽

pp. 699-706

Author(s):

HEMMATPOOR BEHZAD ◽

MAHVAR TAYEBEH ◽

MAKHSOSI BEHNAM REZA ◽

Saeb Morteza

Keyword(s):

Laparoscopic Cholecystectomy ◽

Shoulder Pain ◽

Rating Scale ◽

Controlled Study ◽

P Value ◽

Medical Sciences ◽

Preoperative Administration ◽

Elective Laparoscopic Cholecystectomy ◽

Double Blinded ◽

To Receive

Background: shoulder pain after laparoscopic procedure is a frequent complication encountered in surgery ward. Severaltreatments have been proposed to reduce it. This study aimed to evaluate the efficacy of preoperative administration of gabapentin inpreventing and attenuating Post Laparoscpoic Shoulder Pain (PLSP) after laparoscopic cholecystectomy. Design: In a randomised,double blinded placebo controlled study. Setting: Woman's Hospital, Kermanshah University of Medical Sciences. Period: April 2011 toMarch 2012. Material and methods: 90 patients of ASA physical status I-II undergoing elective laparoscopic cholecystectomy wererandomly allocated to receive gabapentin 600 mg or placebo ,half an hour before surgery. The presence analgesia and side effects wererecorded for 12h postoperatively in same times. Results: Incidence Verbal Rating Scale (VRS) ≥ 4 at different times after arrival to PACUwere significantly lower in gabapentin group in arrival (P Value= 0.003) and then after 30 miniute (P Value= 0.02) and 2 (P Value=0.003), 4 (P Value= 0.03) and 6 (P Value= 0.04) hours after arrival to Post Anesthesia Care Unit (PACU). But this sigificancy lost at 12hours (P Value= 0.07) after arrival to PACU. Also there was a reduction in amounts of postoperative in ward analgesic consumption. Sideeffects were not different between two groups. Conclusions: 600 mg gabapentin as premedication is effective and safe for reducing postlaparoscopicshoulder pain intensity after general laparoscopy compared with placebo.

Download Full-text

QUADRATUS LUMBORUM BLOCK IN PATIENTS OF LAPAROSCOPIC CHOLECYSTECTOMY FOR POSTOPERATIVE ANALGESIA

10.36106/gjra/7515425 ◽

2021 ◽

pp. 187-189

Author(s):

Garima Anant ◽

Aman Kaur ◽

Prakriti Prakriti

Keyword(s):

Laparoscopic Cholecystectomy ◽

Study Data ◽

Detailed History ◽

Quadratus Lumborum Block ◽

Post Operative Pain ◽

Quadratus Lumborum ◽

Fentanyl Consumption ◽

Vas Scores ◽

Group 2 ◽

Group 1

Background: Quadratus lumborum block is done ultrasonographically in thoracolumbar fascial plane at the level of quadratus lumborum muscle to decrease post-operative pain in patients who underwent laparoscopic cholecystectomy . Methods: A prospective, randomized and comparative study was conducted in Pt. B.D. Sharma PGIMS, Rohtak. After informed and written consent, patients were recruited in the study and assigned into 2 groups. A detailed history was taken and examination was carried out. Group 1 patients received Inj.. diclofenac IM (intramuscular) 75 mg and in group 2 Bilateral QL (quadratus lumborum) block was given using 15 ml of 0.25 percent levobupivacaine. The results were measured by VAS score and 24hrs fentanyl consumption. At the end of the study, data was compiled and analyzed using SPSS version 17. Results: In the present study, there was no statistical signicant difference between the two groups. We found that the patients who received quadratus lumborum block had lesser fentanyl consumption and the VAS scores were also better.

Download Full-text

Prospective, Double-Blinded, Randomized, Placebo-Controlled Comparison of Local Anesthetic and Nonsteroidal Anti-Inflammatory Drugs for Postoperative Pain Management after Laparoscopic Surgery

The American Surgeon ◽

10.1177/000313480707300615 ◽

2007 ◽

Vol 73 (6) ◽

pp. 618-624 ◽

Cited By ~ 6

Author(s):

William Newcomb ◽

Amy Lincourt ◽

William Hope ◽

Thomas Schmelzer ◽

Ronald Sing ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Postoperative Pain ◽

Length Of Stay ◽

Oral Administration ◽

Local Anesthetic ◽

Local Infiltration ◽

Elective Laparoscopic Cholecystectomy ◽

Inflammatory Drugs ◽

Anti Inflammatory ◽

Double Blinded

Compared with the open approach, laparoscopy has been shown to significantly reduce postoperative pain. Improving postoperative analgesia in laparoscopic surgery is an area of continued interest. The goal of this study was to compare the efficacy of local anesthetic infiltration with or without preoperative nonsteroidal anti-inflammatory drugs. Patients undergoing elective laparoscopic cholecystectomy were enrolled in an Institutional Review Board-approved, prospective, double-blinded, randomized, placebo-controlled comparison study. Patients were randomized into four groups: Group I, preoperative oral administration of a placebo medication and prein cision local infiltration of 40 mL of 0.5 per cent bupivicaine at trocar sites; Group II, preoperative oral administration of 50 mg of rofecoxib; Group III, preoperative oral administration of 50 mg of rofecoxib and preincision local infiltration of 40 mL of 0.5 per cent bupivicaine into skin, muscle, and peritoneum; and Group IV, preoperative oral administration of a placebo medication. Postoperative pain scores were assessed at 4 hours, 8 hours, 12 hours, and 24 hours using a visual analog scale. Postoperative analgesic use, complications, and length of stay were recorded. Statistical significance was defined as P < 0.05. Fifty-five patients (46 women and 9 men) were enrolled in this study and underwent a standardized, elective, laparoscopic cholecystectomy for mild, symptomatic cholelithiasis (96.4%) and gallbladder polyps (3.6%). No patient had pain immediately before surgery. Postoperative analgesic requests, visual analog scale results, incidence of postoperative vomiting at 4 hours, 8 hours, 12 hours, and 24 hours, in addition to length of stay, were not statistically different between the four groups. No complications occurred. The use of preoperative rofecoxib, 0.5 per cent bupivicaine infiltration, or both for postoperative analgesia did not decrease postoperative pain or decrease length of stay after laparoscopic cholecystectomy compared with placebo. Preoperative administration of an oral anti-inflammatory pain medication, infiltration of a local anesthetic, or both had no greater effect than placebo in controlling discomfort after a laparoscopic cholecystectomy. The challenge of preempting postoperative pain continues and will require further investigation.

Download Full-text