A COMPARISON BETWEEN INSTILLATION OF INTRAPERITIONEAL BUPIVACAINE & MORPHINE vs. BUPIVACAINE ALONE IN ANALGESIA AFTER LAPAROSCOPIC CHOLECYSTECTOMY

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Omar Hany Aly ◽  
Zakaria Abdelaziz Mostafa ◽  
Ehab Hamed Abd El Salam ◽  
Yehia Mamdouh Hassan Mekki
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
University Hospital ◽  
Research Committee ◽  
Analgesic Requirement ◽  
Post Operative Pain ◽  
Dramatic Decline ◽  
Intravenous Morphine ◽  
Intraperitoneal Instillation ◽  
Intraperitoneal Bupivacaine ◽  
Double Blinded

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.

scholarly journals LAPAROSCOPIC CHOLECYSTECTOMY

2016 ◽  
Vol 23 (04) ◽  
pp. 383-388
Author(s):  
Abdul Ghafoor Dalwani ◽  
Ahsan Ali Laghari ◽  
Syed Asad Ali
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Visual Analog Scale ◽  
Descriptive Study ◽  
University Hospital ◽  
Analog Scale ◽  
Analgesic Requirement ◽  
Post Operative Pain ◽  
Alternative Approach ◽  
Operative Complications ◽  
Surgical Unit

With surgeon’s growing experience and advancement of technology laparoscopiccholecystectomy has gone thru many modifications including reduction in number and size ofports. Midline three port laparoscopic cholecystectomy is not performed extensively and istechnically possible. Aim of our study is to see outcome of midline three port laparoscopiccholecystectomy. Study Design: Descriptive study. Period: January 2013 to December 2013.Setting: Surgical unit I, Liaquat University Hospital Jamshoro. Materials and Methods: Midlinethree port laparoscopic cholecystectomy was performed in 75 patients. Outcome of procedureincluded patient’s safety, procedure’s duration, quantitative analgesic requirement, postoperativepain assessed on 10cm visual analog scale after 24 hours, post-operative hospitalstay and post-operative complications. Results: Total of 75 patients underwent midline threeport LC with majority of females 84%. Mean age being43.62±6.85 years. Mean operative timewas 41.30±6.38 minutes. Mean post-operative pain assessed on visual analog scale after24 hours was 2.5±0.45. Maximum site of tenderness was at 10mm subxiphisternal port. 47patients (62.66%) tolerated post-operative pain on NSAID (injection diclofenac), while remaining28 patients (37.33%) required additional opiate (injection Nalbuphine). Mean post-operativehospital stay was 1.186 ±0.60 days. 1patient (1.33%) had port site infection. Conclusion:Midline three port laparoscopic cholecystectomy prevents one extra scar of traditional 4portlaparoscopic cholecystectomy. This technique is safe, efficient and feasible. This techniquecan be used as an alternative approach to traditional 4 port laparoscopic cholecystectomy inuncomplicated cases.

Tranversus Abdominus Plane Block with or without Magnesium Sulphate on Postoperative Pain Control after Open Appendectomy Operation

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Menna A Elzyat ◽  
Nevine A Kaschef ◽  
Rania M Hussien ◽  
Simon H Armanios
Keyword(s):  
Magnesium Sulphate ◽  
Controlled Trial ◽  
Open Appendectomy ◽  
Transversus Abdominis ◽  
University Hospital ◽  
Tap Block ◽  
Rescue Dose ◽  
Post Operative Pain ◽  
Number Of Patients ◽  
Double Blinded

Abstract Background Patients undergoing Open Appendectomy experience pain postoperatively, requiring a multimodal approach to analgesia. The transversus abdominis plane (TAP) block seems to be an ideal approach. This block may be achieved using bupivacaine with adjuvants such as magnesium sulfate, which we were used in this study. Aim of the Work to detect the efficacy and safety of magnesium sulphate as an adjuvant to the analgesia offered by local anesthetic in ultrasound guided TAP block in patients undergoing open appendectomy. Patients and Methods A prospective double blinded randomized controlled trial was conducted on 60 patients undergoing open appendectomy at Ain Shams University Hospital, Cairo, Egypt. Results Our study concluded that co administration of 500mg MgSo4 to 0.5 % bupivacaine in US guided TAP block lead to: Significant decrease in VAS pain score especially at 4hrs, 6hrs and 12hrs,1st rescue dose of nalbuphine was delayed. And number of patients require rescue doses of nalbuphine in 1st 4 hrs, while only 2 patients require rescue doses of nalbuphine between 4&6 hrs.4 patients require rescue doses of nalbuphine between 6&12 hrs, while 26 patients require rescue doses of nalubuphine between 12&24hrs. we also cocluded that there were a significant decrease in HR and MABP especially at 4hrs and 6 hrs postoperative,. Conclusion MgSO4 as an adjuvant to bupivacaine in Ultra-sounded guided TAP block reduces post-operative pain scores, prolong the duration of analgesia and decreases demand for rescue analgesics.

Assessment of Effect of Port Site and Intraperitoneal Instillation of Bupivacaine in Reduction of Post-Operative Pain After Laparoscopic Cholecystectomy

2020 ◽  
Author(s):  
Nippun Roy
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Pain Assessment ◽  
Pain Control ◽  
Port Site ◽  
Controlled Study ◽  
Control Group ◽  
Local Infiltration ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Intraperitoneal Instillation

Aim: Effective postoperative pain control is an essential component for care of surgical patients. Inadequate pain control may result in increased morbidity or mortality. Analgesic effects of periportal infiltration of local anesthetics, infiltration of periportal parietal peritoneum, intraperitoneal spraying at subdiaphragmatic space and subhepatic space covering the area of hepatoduodenal ligament have been reported. The present controlled study aimed at assessing the effect of port site injection and intraperitoneal instillation of bupivacaine in reduction of post-operative pain after laparoscopic cholecystectomy. Methods: The present study was conducted among a group of 180 patients diagnosed to have symptomatic cholelithiasis and who underwent elective laparoscopic cholecystectomy under general anesthesia. In group 1, pre-incisional local infiltration of 20ml 0.5% bupivacaine at the port sites; and in group 2, local infiltration of 20ml 0.5% bupivacaine at the port sites with intraperitonial installation. In group 3, no local infiltration was done and treated as control group. Pain assessment is based on a Universal Pain Assessment Tool. Analysis of our study was performed one-way ANOVA & Post HOC test (Scheffe's HSD) & Chi square tests as and when indicated. Results: Mean pain scores at 30 minutes were significantly lower in groups 1 & 2 compared to control group; but however, the values were not significantly different when compared to each other. Similarly, the mean pain scores at 4th, 8th, 16th and 24th hours for the preincisional and preclosure groups, didn't signify any inter-group advantage. Therefore, bupivacaine provides a substantial reduction of pain intensity up to 24 hours postoperatively; and was found to be statistically significant. However, timing of anesthesia was found to be statistically insignificant in terms of preclosure vs pre incisional of the port sites. Conclusion: Instillation of bupivacaine at the port sites in laparoscopic cholecystectomy irrespective of the timing of instillation is an effective method of achieving pain control in the post-operative period as long as 24 hours after surgery. There was no statistically significant reduction of post-operative pain between the pre-incisional and pre-closure groups.

EFFICACY OF INTRAPERITONEAL INSTILLATION OF 0.2% ROPIVACAINE FOR POSTOPERATIVE PAIN RELIEF AFTER LAPAROSCOPIC CHOLECYSTECTOMY

2021 ◽  
pp. 13-15
Author(s):  
Debottam Gangopadhyay ◽  
Rahul Agarwal
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Pain Perception ◽  
Study Drug ◽  
Postoperative Pain Relief ◽  
Analgesic Requirement ◽  
Rescue Analgesia ◽  
Intraperitoneal Instillation ◽  
Study Population

INTRODUCTION: Postoperative pain management is one of most important components of adequate postoperative patient care. Poorly treated pain contributes to patient suffering and may prevent rapid recovery and rehabilitation. Laparoscopic operative procedures have revolutionized surgery with many advantages : a smaller and more cosmetic incision, reduced blood loss, reduced postoperative hospital stay and pain, which cut 1 down hospital costs . AIMS AND OBJECTIVES:Aim of the study is to evaluate the efcacy of intraperitoneal instillation of ropivacaine for postoperative pain relief after laparoscopic cholecystectomy surgeries in terms of : Duration of analgesia, 24 hour postoperative analgesic requirement, Postoperative pain assessment, Postoperative hemodynamic changes like pulse rate, blood pressure and Complications (if any). MATERIALS AND METHODS: Study area -Command Hospital (Eastern Command), Alipore, Kolkata (operation theatre and ward). Study population - Patients posted for Elective Laparoscopic Cholecystectomy. Study period -Jan 2017 to June 2018 Study Time– From rst intraoperative intraperitoneal instillation of study drug to next 24 postoperative hours. Sample Size - 80 (40 in each group) RESULTS AND ANALYSIS: In our study, intraperitoneal instillation of Ropivacaine at the end of surgery provided analgesia for 5.54 ± 4.61 hrs. When compared with the saline group, it was about 2.22 ± 2.93 hrs, which was found to be statistically signicant (-0.004). In this study, Injection Tramadol was used for rescue analgesia for postoperative pain relief. SUMMARYAND CONCLUSION: This study has a few limitations. First, eighty study population may be underpowered for the study. Second, the surgeon performing the surgeries is not the same in every case which may alter the postoperative consequences. From this study it may be concluded that intraperitoneal instillation of Ropivacaine is effective for postoperative pain relief after laparoscopic cholecystectomy. From this study we also conclude that, intraperitoneal instillation of Ropivacaine is useful for postoperative pain relief for patients undergoing laparoscopic cholecystectomy in terms of duration of analgesia, rescue analgesic requirement and pain perception.

Clinical trial to assess role of ketamine in post operative analgesia after laparoscopic cholecystectomy

2021 ◽  
Vol 23 (05) ◽  
pp. 421-432
Author(s):  
Dr. Mohammad Kheiri Mahmod ◽  
◽  
Dr. Bashar Naser Hussein ◽  
Dr. Ammar Hamid Hanoosh ◽  
◽  
...  
Keyword(s):  
Clinical Trial ◽  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Analgesic Effect ◽  
Analgesic Requirement ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: The physiological consequences of post-operative pain including Stress response to surgery, Respiratory complications, cardiovascular complications, Thromboembolic complications, Gastrointestinal complications, Musculoskeletal complications and Psychological complications, all of which could delay or impair postoperative recovery and increase the economic cost of surgery as a result of the longer period of hospitalization. Inadequate post-operative pain control may also lead to the development of chronic pain after surgery .Aim of This study: is to evaluate the preemptive analgesic effect of intravenous ketamine in laparoscopic cholecystectomy. Patients and Methods: double blinded randomized clinical trial conducted at Al-Yarmouk teaching hospital, over a period of one year from March 2013 to March 2014 on a total of 120 adult patients scheduled for elective laparoscopic cholecystectomy, Patients were divided in to three groups of 40 patients each, the study drug administered intravenously during induction. Groups A and B received ketamine in a dose of 1 and 0.5 mg/kg, respectively, whereas group C received isotonic saline. The degree of pain at rest and deep breathing postoperatively were estimated using VAS, time of first analgesic dose, total opioid consumption, nausea, vomiting and hallucination were recorded for 24 h postoperatively. Results: postoperative pain scores were significantly low in group A when compared with the other groups at most times in the first 24 hours. Highest pain score was in group C at 0 h. Postoperative analgesic consumption was minimum in group A then group B and highest in group C. There was little significant difference in the pain scores between groups B and C. Group A had a significantly higher blood MAP than group B at 0, 0.5 and 1 h. 7.5% incidence of hallucinations were in group A. Conclusion: According to this study we conclude that preemptive ketamine in a dose of 1 mg/kg has a definitive role in reducing postoperative pain and analgesic requirement in patients undergoing laparoscopic cholecystectomy. A low dose of 0.5 mg/kg had little significant in preemptive analgesic effect and in reducing analgesic requirement.

scholarly journals Intraperitoneal magnesium sulphate plus bupivacaine for pain relief after laparoscopic cholecystectomy

2012 ◽  
Vol 1 (1) ◽  
pp. 21-25
Author(s):  
SK Maharjan ◽  
S Shrestha
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Pain Relief ◽  
Visual Analogue Scale ◽  
Scale Score ◽  
Visual Analogue Scale Score ◽  
Magnesium Sulphate ◽  
Analogue Scale ◽  
Sulphate Group ◽  
Intraperitoneal Instillation ◽  
Intraperitoneal Bupivacaine

Background: Multimodal analgesia is necessary for management of pain after laparoscopic cholecystectomy. Magnesium sulphate is a new emerging drug for management of acute pain. This study was performed to study the analgesic efficacy of intraperitoneal bupivacaine and bupivacaine plus magnesium sulphate for postoperative pain relief after laparoscopic cholecystectomy. Methods: At the end of laparoscopic cholecystectomy, 60 patients were randomized to one of the following groups: bupivacaine group receiving intraperitoneal instillation of 30 ml of 0.25% bupivacaine and magnesium sulphate group receiving intraperitoneal instillation of 0.25% bupivacaine plus 50 mg/kg magnesium sulphate to total volume of 30 ml. Postoperative pain was evaluated by using visual analogue scale (standard Visual Analogue Scale pain score of 0-10). Time duration of first analgesia demanded was noted and rescue analgesic was given as tramadol 50 mg intravenously and on demand. Pain, Visual Analogue Scale score and total analgesic consumption was recorded for 24 hours and analysed. Results: The patients who were given intraperitoneal bupivacaine plus magnesium sulphate at the end of surgery had better pain relief in first 24 hours, Visual Analogue Scale score of 0-5 compared to sole bupivacaine group who had Visual Analogue Scale score of 3-7. The magnesium sulphate group had longer pain free period of average 5.53±4.33 hours after surgery compared to 3.16±1.59 hours in sole bupivacaine group. Total analgesic consumption in magnesium sulphate group was also less compared to bupivacaine group (125.0±36.5 and 75.0±25.0 in bupivacaine and magnesium sulphate group respectively). All the results show highly significant differences between the groups. Conclusion: The combined instillation of bupivacaine and magnesium sulphate into the peritoneal cavity at the end of laparoscopic surgery renders patients better pain control and less consumption of analgesics in first 24 hours compared to sole bupivacaine group. DOI: http://dx.doi.org/10.3126/jkmc.v1i1.7251 Journal of Kathmandu Medical College, Vol. 1, No. 1, Issue 1, Jul.-Sep., 2012 pp.21-25

scholarly journals Comparison of intraperitoneal instillation of ropivacaine with normal saline in laparoscopic cholecystectomy

2017 ◽  
Vol 5 (11) ◽  
pp. 4924 ◽  
Author(s):  
Tripat Kaur Bindra ◽  
Davinder Chawla ◽  
Parmod Kumar ◽  
. Parul
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Side Effects ◽  
Double Blind Study ◽  
Analgesic Requirement ◽  
Double Blind ◽  
Analgesic Consumption ◽  
Vas Score ◽  
Group I ◽  
Intraperitoneal Instillation ◽  
Group Ii

Background: Local anesthetics are now widely used, as they have a good safety profile and are available in long acting preparation. They provide the benefit of analgesia without systemic side effects that may result from use of enterally and parenterally administered drugs.Methods: This prospective randomized double-blind study was conducted on 100 patients with symptomatic gall stones disease undergoing laparoscopic cholecystectomy. Patients were randomized to receive either 0.5% of 3mg/kg of Ropivacaine diluted in 100 ml NS, instillation at intraperitoneal space before creation of pneumoperitoneum (group I) or 100 ml NS instillation at intra peritoneal space before creation of pneumoperitoneum (group II). VAS score for pain abdomen as well as shoulder were recorded postoperatively at various time intervals and compared in both the groups. Total analgesic consumption in 24hrs was also noted and compared.Results: The mean postoperative VAS score for abdomen and shoulder pain was significantly (p values<0.05) lower in group I than in group II till 24 hrs postoperatively. The latency time from end of operation to first analgesic requirement was significantly longer in group I than in group II.Conclusions: Intraperitoneal instillation of Ropivacaine before the creation of pneumoperitoneum significantly decreased the total abdominal pain, shoulder tip pain with lower analgesic consumption. As it is safe and without apparent side effects, we believe that intraperitoneal instillation of local anaesthetic in patients undergoing elective laparoscopic cholecystectomy is an effective modality for postoperative pain management.

A COMPARATIVE STUDY OF POSTOPERATIVE ANALGESIA FROM INTRAPERITONEAL INSTILLATION OF ROPIVACAINE V/S ROPIVACAINE + FENTANYL IN LAPAROSCOPIC CHOLECYSTECTOMY SURGERIES

2021 ◽  
pp. 59-63
Author(s):  
Vaibhavi j. Hajariwala ◽  
Disha Baxi ◽  
Birva Khara ◽  
Bhumika Pathak
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Adverse Effects ◽  
Normal Saline ◽  
Pain Perception ◽  
P Value ◽  
Chi Square ◽  
Exact Test ◽  
Institutional Ethics ◽  
Post Operative Pain ◽  
Intraperitoneal Instillation

Background and Aim: This study is designed and conducted to compare the efcacy of intra-peritoneal instillation of ropivacaine to that of a combination of ropivacaine and fentanyl in reducing post-operative pain and the side effects of the same. Aim: To compare the effects of intra-peritoneal instillation of ropivacaine to a combination of ropivacaine and fentanyl on postoperative morbidity in terms of: 1. Post-operative pain 2. Post-operative adverse effects Methods and Material: After approval of the Institutional Ethics Committee (IEC) [IEC/HMPCMCE/105/Faculty/12/107/19] and the Clinical Trials Registry of India [CTRI/2020/04/024616], consenting patients were randomized into two groups of 26 participants each. One group was given intraperitoneal instillation with 15ml of ropivacaine 0.75% diluted in normal saline to make a solution of 45ml and other group was given 15ml of 0.75% ropivacaine with fentanyl 50mcg(1ml) diluted in normal saline to make a solution of 45ml, intra-operatively, and post-operative pain perception and occurrence of adverse effects was recorded. Statistical Analysis: Two sample t-test with equal variances, chi-square test and Fisher's exact test. P value<0.05 was considered signicant Results: Group receiving intraperitoneal instillation of plain ropivacaine was found to have signicantly higher VAS scores and VRS scores (p<0.001) and lesser mean time to requirement of rst-dose of analgesic post-operatively (p<0.001), and lesser incidence of bradycardia (p=0.01) Conclusion: Intraperitoneal instillation of combination of ropivacaine and fentanyl is superior to ropivacaine alone for reducing post-operative pain in patients undergoing laparoscopic cholecystectomy surgery.

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