An investigation into the effect of depth of anesthesia on postoperative pain in laparoscopic cholecystectomy surgery: a double-blind clinical trial

Abstract Background: As a part of multimodal analgesia for laparoscopic cholecystectomy, administration of systemic lidocaine is a well-known technique. Similarly, esmolol has been found to have an opioid sparing effect in the perioperative setting. The aim of the study was to compare opioid consumption after an intraoperative infusion of lidocaine or esmolol in female patients undergoing elective laparoscopic cholecystectomy. Methods: In this prospective, randomized, double-blind clinical trial, 90 female patients scheduled for elective laparoscopic cholecystectomy received either IV lidocaine bolus 1.5 mg/kg at induction followed by infusion of 1.5 mg/ kg/hr or IV bolus of esmolol 0.5 mg/kg at induction followed by infusion of 5-15 µg/kg/min till the end of surgery. Standard anaesthetic protocol was followed. Postoperatively, patients received either IV morphine or tramadol to maintain VAS scores ≤ 3. The primary outcome was opioid consumption in the first 24 h after surgery. Pain and sedation scores, time to first perception of pain and void, and incidence of nausea/vomiting were secondary parameters measured up to 24 h postoperatively. Results: Two patients in each group were excluded from the analysis. The postoperative median morphine consumption in patients receiving lidocaine and esmolol was 1.5 (1-2) mg and 1 (0-1.5) mg respectively (p=0.27). The median pain scores at various time intervals were comparable between the two groups (p>0.05). More patients receiving lidocaine were sedated in the PACU than those receiving esmolol (p<0.05); however, no difference was detected later. Conclusion: There was no difference in postoperative opioid requirement and VAS score for pain in the first 24 h of surgery between the lidocaine and esmolol group. Patients receiving lidocaine were more sedated than those receiving esmolol in the early period after surgery.

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The efficacy of antibiotic prophylaxis for impacted and semi-impacted third molar surgery: A prospective randomized double-blind clinical trial

Research Society and Development ◽

10.33448/rsd-v10i9.18398 ◽

2021 ◽

Vol 10 (9) ◽

pp. e58610918398

Author(s):

Ana Paula Silva Gangá ◽

Henrique Augusto Pautz Tarantino ◽

Natália Bermond Arpini ◽

Tatiany Pimentel Ferreira ◽

Paula Sampaio de Mello ◽

...

Keyword(s):

Clinical Trial ◽

Postoperative Pain ◽

Antibiotic Prophylaxis ◽

Third Molar ◽

Dental Students ◽

Third Molar Surgery ◽

Resistant Bacteria ◽

Double Blind ◽

Impacted Third Molar ◽

Double Blind Clinical Trial

Impacted and semi-impacted third molar surgery is a frequent dental procedure. Due to potentially major tissue manipulation during surgery, antibiotic prophylaxis may be indicated to prevent infection of the surgical wound. This study evaluated the surgical conditions of patients following extraction of impacted and semi-impacted third molars with or without prior antibiotic prophylaxis. Signs of infection and inflammation, postoperative pain level and efficacy of the prescribed drugs were recorded. This was a prospective, randomized, double blind clinical trial with split-mouth design. A total of 23 healthy (ASA I) volunteers with indication for bilateral mandibular third molar extraction were recruited, totaling 46 surgical procedures. One hour prior to the procedure, volunteers received 1g of amoxicillin or placebo and a drug for pain prevention and control. The surgical acts were performed by last-year dental students. Postoperative pain was assessed using a visual analogue scale and an 11-point box scale at selected postoperative intervals of 4 h, 12 h, and 24 h. After seven postoperative days, study volunteers were examined for clinical signs of infection and/or inflammation, such as pus, intra and extraoral swelling, trismus, heat, flushing and temperature change. There were only two cases of postoperative complications, one of intraoral edema (placebo group) and one of trismus (antibiotic prophylaxis group). There were no statistically significant differences for any of the indicative signs of infection. The pain scales revealed no differences between pain levels in both groups at all times evaluated, regardless of the pain scale used (P > 0.05). To conclude, the low infection rate observed in our study does not reflect any need for antibiotic prescription in systemically healthy patients. The adverse effects of antibiotics in addition to selection for resistant bacteria outweigh the benefits of antibiotic prophylaxis in healthy (ASA I) patients.

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