scholarly journals Paracetamol versus Diclofenac as Intravenous Post-Operative Analgesia in Patients after Laparoscopic Surgeries

2021 ◽  
Vol 8 (11) ◽  
pp. 613-617
Author(s):  
Ashwanth Bagavannathan Adiththan ◽  
Ramya Natarajan ◽  
Sanmuga Piriya Krishnan ◽  
Suneeth P. Lazarus
Keyword(s):  
Subjective Experience ◽  
Recovery Period ◽  
P Value ◽  
Double Blind ◽  
Rescue Analgesia ◽  
Haemodynamic Stability ◽  
High Pain Score ◽  
Intravenous Paracetamol ◽  
Study Results ◽  
Post Operative Nausea

BACKGROUND Laparoscopic surgery is becoming a widely used procedure in recent days due to its minimal invasive nature and faster recovery. Pain is a stressful stimulus in postoperative period. Pain is a subjective experience. Poor pain management may hinder better postoperative outcome, leading to patient suffering and lengthened recovery period. We wanted to compare the efficacy of intravenous paracetamol and intravenous diclofenac for post-operative analgesia following laparoscopic surgeries. METHODS This randomised controlled double-blind prospective study was conducted between October 2017 and May 2019 among 48 participants posted for laparoscopic abdominal surgeries, block randomised into 24 participants each in 2 groups. All patients were given general anaesthesia and 30 minutes prior to extubation patients were given the test drug according to the groups assigned using closed envelop technique. The test drugs were continued post operatively at prescribed intervals. Visual analogue score (VAS) score, systolic and diastolic blood pressure (BP) and heart rate were monitored at 2, 4, 6, 12 and 24 hours postoperatively. Furthermore, need for rescue analgesia with inj. tramadol 50 mg intramuscular (IM) and post-operative nausea and vomiting (PONV) were noted. RESULTS The study results showed increased pain scores in diclofenac group up to 12 hours but were statistically insignificant. High pain score was seen in diclofenac group at 24 hours with statically significant P-value of 0.022 and PONV occurring in 3 patients. Paracetamol group had better haemodynamic stability. CONCLUSIONS Intravenous paracetamol and intravenous diclofenac were found to be equally effective in post-operative analgesia in patients undergoing laparoscopic surgeries; however, paracetamol has an advantage of providing better analgesia for longer duration with better haemodynamic stability. KEYWORDS Intravenous Paracetamol, Intravenous Diclofenac, Laparoscopic Surgeries, PostOperative Analgesia

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

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.

scholarly journals Comparative Study of Effect of Etomidate Versus Propofol plus Ketamine on Haemodynamic Response to Laryngoscopy and Endotracheal Intubation

2021 ◽  
Vol 8 (15) ◽  
pp. 939-944
Author(s):  
Saraswathi Ramakrishna ◽  
Langpoklakpam Chaoba Singh ◽  
Bijaya Chingtham ◽  
Rahul Jain
Keyword(s):  
Endotracheal Intubation ◽  
Side Effect ◽  
Controlled Trial ◽  
Double Blind ◽  
Haemodynamic Stability ◽  
Significant Difference ◽  
Haemodynamic Changes ◽  
Drug Induction ◽  
Randomised Controlled ◽  
Post Operative Nausea

BACKGROUND Laryngoscopy and endotracheal intubation, a painful procedure, frequently used in airway management is commonly associated with undesired haemodynamic changes like hypertension, tachycardia and arrythmias. Thus, this study was designed to compare haemodynamic stability to laryngoscopy and intubation using single drug induction with etomidate and combined drug induction with propofol and ketamine. METHODS This was a double blind randomised controlled trial, a total of 90 patients of both sexes, aged between 18 - 60 years, who were scheduled for elective surgeries under general anaesthesia in regional institute of medical sciences (RIMS) operation theatre (OT) were divided into two groups. Group PK received propofol (1.5 mg / kg) + ketamine (0.5 mg / kg) and Group E received etomidate (0.3 mg / kg) as induction agents. The haemodynamic parameters (systolic blood pressureSBP, diastolic blood pressure-DBP, mean arterial pressure-MAP, heart rate-HR) were recorded before induction, immediately after induction, 1, 3 and 5 mins after intubation. Side effects like myoclonus and post-operative nausea and vomiting were also noted. RESULTS SBP, DBP, MAP which were recorded, before induction considered as the baseline, and after induction, were comparable between the two groups. SBP, DBP and MAP compared at 1, 3 and 5 mins after intubation showed statistically significant difference between the two groups with propofol-ketamine group showing better haemodynamic stability. The HR between both the groups at various time intervals were comparable and not considered statistically significant. The side effect associated after induction was myoclonus in 14 patients in Group E i.e. 31 % and post-operative nausea vomiting was observed in 8 patients in Group E i.e. 18 %. CONCLUSIONS Thus, in view of haemodynamic stability during laryngoscopy, intubation and side effect profile; propofol and ketamine combination proves to be a better alternative compared to etomidate according to our study. KEYWORDS Propofol, Ketamine, Etomidate, Haemodynamic Stability

scholarly journals Multi-Modal Analgesic Technique for Pain Control in Patients Undergoing Diagnostic Gynecological Laparoscopy: Randomized Controlled Clinical Trial

2019 ◽  
Vol 7 (8) ◽  
pp. 1324-1329 ◽  
Author(s):  
Sherin Refaat ◽  
Ashraf Ali Mawgood ◽  
Mohamed Al Sonbaty ◽  
Maged Gamal ◽  
Abdelrazik Ahmed
Keyword(s):  
Recruitment Maneuver ◽  
Controlled Clinical Trial ◽  
P Value ◽  
Double Blind Study ◽  
Double Blind ◽  
Rescue Analgesia ◽  
Gynaecological Laparoscopy ◽  
Significant Difference ◽  
Analgesic Technique ◽  
Pulmonary Recruitment Maneuver

BACKGROUND: Advancement in minimally invasive laparoscopic surgeries make it one of the best choices for both the surgeon and the patient. The anesthesiologist had to improve the techniques used to control post-operative pain. AIM: In this study, we hyposethized that multi-modal analgesic technique which is a combination of two simple techniques (intraperitoneal lidocaine and pulmonary recruitment) allow better result than using only one of them. PATIENTS AND METHOD: This randomised controlled, double-blind study was conducted in Kasr-Alainy hospital, faculty of medicine, Cairo University, Egypt from September 2017 till February 2018. Fifty female patients, scheduled for diagnostic gynecologic laparoscopy were included in the study. Patients were randomly allocated using random computer allocation with numbered closed opaque envelopes into four study group. GM (n = 12): Patients received pulmonary recruitment maneuver and intra-peritoneal Lidocaine, GL (n = 13): Patients received intra-peritoneal Lidocaine, GP (n = 13): Patients received Pulmonary Recruitment Maneuver, GC (n = 12): Patients received passive exsufflation through the port site. In the ward, patients were asked to fulfil a questionnaire about pain severity using (VAS) at 1, 3, 6-hour post-operative both the patients and the anesthesiologist that assess the (VAS) were blind of the patient group RESULTS: Regarding pain score between groups VAS 1 (the primary outcome) was lowest in GM {4.5 (3-5)} in comparison with other groups (P value = 0.015). While VAS 3 & VAS 6 wasn’t statistically significant between groups. Regarding Time of first rescue analgesia; GM {3 (1.75-4)} showed the longest time in between groups (P-value = 0.042). As regard nausea and vomiting; there was no statistically significant difference in in-between groups. CONCLUSION: Application of Multi-modal analgesic technique allows better analgesia for a longer duration than the use of the sole technique for control of abdominal pain in patients undergoing diagnostic gynaecological laparoscopy.

scholarly journals Comparative study of diclofenac suppository with tramadol suppository in addition to acetaminophen for post caesarian analgesia

2020 ◽  
Vol 9 (4) ◽  
pp. 1372
Author(s):  
Reetu Hooda ◽  
Prachi Pathak ◽  
Rahul Chavhan
Keyword(s):  
Caesarean Section ◽  
Elective Caesarean Section ◽  
P Value ◽  
Breastfeeding Initiation ◽  
Double Blind ◽  
Rescue Analgesia ◽  
Vas Score ◽  
Rectal Suppository ◽  
Group A ◽  
Group B

Background: Pain after emergency and elective caesarean section may adversely affect patient’s recovery and breastfeeding initiation. The aim of present study was to compare the analgesic efficacy of diclofenac suppository-intravenous acetaminophen (APAP) combination, tramadol suppository-intravenous APAP combination and intravenous APAP alone for postoperative pain relief after caesarean section.Methods: We designed a randomized double-blind control study. Three hundred parturient scheduled for caesarean section were randomized to receive diclofenac rectal suppository (100 mg), tramadol rectal suppository (100 mg) or glycerin rectal suppository in Group A, B and C respectively (100 parturient in each group). All the women routinely received 1000 mg acetaminophen intravenously. Assessment of pain was done using a visual analogue scale (VAS) at 0, 1, 6, 12, 18 and 24 hours. injection Pentazocine 0.3 mg/kg IV was given as rescue analgesia when VAS score > 30.Results: The mean VAS score was significantly higher in Group C as compared to Group A and Group B (p value < 0.001). This suggests better efficacy of multimodal treatment as compared to monotherapy. Group A as compared to Group B showed better efficacy in term of VAS score at 12 and 18 hours (p = 0.05, p = 0.02 respectively).Conclusions: We found that when controlling for socio-demographic characteristics, combination of either diclofenac or tramadol suppository with acetaminophen has significantly better results when compared with monotherapy of acetaminophen alone in post-operative analgesia after caesarean section. However, the combination of diclofenac suppository has proved to be superior in comparison to tramadol suppository.

scholarly journals A study to assess the effect of a single pre-operative dose of steroid in major abdominal surgery outcomes

2020 ◽  
Vol 8 (1) ◽  
pp. 312
Author(s):  
Ajai Kunnath Sarasijakshan ◽  
Sunil Sadanandan ◽  
Joseph Francis
Keyword(s):  
Abdominal Surgery ◽  
Severe Pain ◽  
Saline Group ◽  
High Rate ◽  
P Value ◽  
Chi Square ◽  
Dexamethasone Group ◽  
Study Results ◽  
Post Operative Nausea ◽  
Double Blinded

Background: Abdominal surgeries are associated with an appreciably high rate of post-operative nausea, vomiting and pain due to the severity of the proinflammatory cytokine response arising from peritoneal trauma. This study was designed to study the efficacy of single pre-operative dose of dexamethasone in reducing the incidence of post-operative nausea, vomiting and pain after major abdominal surgeries.  Methods: The study was prospective, randomized and double blinded. 60 adult patients of either sex, scheduled for elective laparotomy from March 2012 to October 2013 were included in the study. Results: In this study 86.7% of patients in the saline group experienced nausea, whereas only 13.3% of patients in dexamethasone group experienced nausea. Chi square value is 32.67 and p value is<0.05. Among the patients who received dexamethasone only 10% experienced vomiting, where as in the saline group 33.3% developed vomiting. Chi square value is 4.812 and p value is 0.029. This is statistically significant as p value is<0.05. Among the patients who experienced very severe pain 100% were from the saline group, whereas none of the patients in dexamethasone group experienced very severe pain. Among the patients who experienced severe pain 85.7% belonged to saline group, and only 14.3% were from the dexamethasone group. The p value is<0.05.  Conclusions: It was found that single pre-operative dose of dexamethasone (8 mg) reduces post-operative nausea, vomiting, pain significantly after abdominal surgery.

scholarly journals Ondansetron for Prevention of Post-Operative Nausea and Vomiting (PONV) in General Surgery Patients

2021 ◽  
pp. 35-39
Author(s):  
Muhammad Naeem ◽  
Rafia Tabassum ◽  
Muhammad Saleh Khaskheli ◽  
Aijaz Hussain Awan ◽  
Munazzah Meraj ◽  
...  
Keyword(s):  
Single Dose ◽  
General Surgery ◽  
Cross Sectional Study ◽  
Health Sciences ◽  
P Value ◽  
Sectional Study ◽  
Cross Sectional ◽  
Study Results ◽  
Operative Complications ◽  
Post Operative Nausea

Aim: To determine the efficacy of single dose ondansetron in preventing PONV in patients. Methodology: In this cross sectional study 49 patients were given Ondansetron.  Every patient was evaluated for PONV at 1, 2, 3, 6, 12 and 24 hours post operatively. This study was conducted at General surgery operation theatres and surgical wards I, II, III and Department of Anesthesia and SICU Peoples University of Medical & Health Sciences for women Nawabshah, District Shaheed Benazirabad, Sindh. Results: A sample of 49 patients with age between 20-60 years (mean age 43.72±5.67 years), 35% male and 65% female was included in this study. In this study ondansetron was given (N=49) 4 mg I/V before induction. Regarding complications there was not significant (p ≤0.05) POVN was observed. Conclusion: Our study results showed in patients who received ondansetron regarding frequency of post operative complications (PONV) showed insignificant results as no p-value is found to be ≤0.05.It was concluded that a single dose of ondansetron is very effective in preventing PONV in general surgery patients.

scholarly journals Comparison of Ropivacaine 0.2% Alone and in Combination with Fentanyl for Caudal Anesthesia in Paediatric Patients

2019 ◽  
Vol 4 (02) ◽  
Author(s):  
Dr. Tejinderpal Kaur Grewal ◽  
Dr. Balwinder Kaur ◽  
Dr. Parmod Kumar ◽  
Dr. Sukhdeep Kaur
Keyword(s):  
Randomized Study ◽  
Analgesic Efficacy ◽  
Epidural Block ◽  
P Value ◽  
Double Blind ◽  
Duration Of Action ◽  
Rescue Analgesia ◽  
Neuraxial Blockade ◽  
Paediatric Patients ◽  
Caudal Anaesthesia

Background: Caudal epidural block is one of the most common regional techniques in paediatric anesthesia. It is safe, easy to perform and has been found to be very effective in children undergoing infra-umbilical surgeries .Ropivacaine produces differential neuraxial blockade with less motor block and reduced cardiovascular toxicity. Various adjuvants are added to increase the duration of action of local anesthetics. The aim of our study was to evaluate the action of fentanyl on duration of postoperative analgesia when added as an adjunct to ropivacaine in paediatric population of age 3-8 years undergoing infraumbilical surgeries. Methods: A double blind, prospective, comparative and randomized study was conducted on 50 paediatric patients undergoing elective infraumbilical surgery. Patients were randomly divided into two groups of 25 each by simple envelope method. After securing airway, caudal anaesthesia was given. Group R received 0.2% ropivacaine 0.5ml/kg and Group RF – received 0.2% ropivacaine 0.5ml/kg with fentanyl 0.5mcg/kg. Post-operative pain was assessed by face, legs, activity, cry and consolability pain assessment scale for 24 h. Duration of motor blockade and side effects were noted. The hemodynamics, duration of post-operative analgesia and number of rescue analgesia needed was noted and analyzed statistically. Results: Mean duration of analgesia in ropivacaine group is 441.60±102.29 minutes (7.35hrs) and in ropivacaine fentanyl group was 892±313.84 (14.86hrs). Statistically the difference was highly significant as p value was <0.001. Conclusions: Fentanyl as an adjuvant to ropivacaine for caudal block has significantly improved analgesic efficacy and increased the duration of post-operative analgesia in children undergoing infraumbilical surgery.

Penatalaksanaan IMD pada Ibu Postpartum Sectio Caesarea Mempengaruhi Status Gizi dan Kecepatan Produksi ASI

2020 ◽  
Vol 2 (2) ◽  
pp. 112-120
Author(s):  
Nursari Abdul Syukur ◽  
Susi Purwanti
Keyword(s):  
Breast Milk ◽  
Nutritional Status ◽  
Milk Production ◽  
Quantitative Research ◽  
Milk Protein ◽  
Sectio Caesarea ◽  
Control Group ◽  
P Value ◽  
Study Results

Many mothers who give birth to Sectio Caesarea (SC) do not Initiate Early Breastfeeding (IMD), which fails exclusive breastfeeding. This study aimed to determine the effect of IMD management in postpartum SC mothers on nutritional status, speed of milk production, and quality of breast milk protein. Method: quantitative research with quasi approach experiment. The research design used was a pre-post-test control non-equivalent control group. A sampling of this study used the Consecutive method sampling with a sample of 20 mothers who gave birth by cesarean section (SC). Hypothesis testing uses the independent t-test and the Mann-Whitney test. The study results showed an influence on the management of IMD in postpartum SC mothers on the speed of ASI production (p-value=0.004) and nutritional status (p-value=0.028). There was no effect of IMD management on postpartum SC mothers on the quality of breast milk protein (p-value = 0.543). This study recommends that the hospital implement an IMD promotion program before the abdominal wall is closed as a form of intervention to increase milk production and maternal nutritional status

A STUDY OF ENDOMETRIAL THICKNESS IN TRANS VAGINAL SONOGRAPHY IN RELATION WITH HISTOPATHOLOGY REPORT IN DILATION & CURRATAGE IN AUB WOMEN

2019 ◽  
pp. 1-2
Keyword(s):  
Comparative Study ◽  
Endometrial Thickness ◽  
P Value ◽  
First Line ◽  
Non Invasive ◽  
Dilation And Curettage ◽  
Study Results ◽  
Vaginal Sonography ◽  
In Trans

A study of of endometrial thickness on TVS in relation with histopathology report on dilation and curettage. AIM AND OBJECTIVE-To set a cut off limit of endometrial thickness on TVS for differtiating between normal and abnormal endometrium. MATERIAL AND METHOD-hospital based comparative study. RESULTS-TVS is non invasive ,simple first line procedure in AUB women. Mean endometrial thickness in normal endometrial group was 8.00±2.44 mm and in abnormal endometrial group was 15.16±33 mm.The difference was found highly significant (p value<.001)

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