scholarly journals COMPARATIVE STUDY OF FENTANYL, TRAMADOL AND NALBUPHINE IN ATTENUATION OF HAEMODYNAMIC RESPONSES IN LAPAROSCOPIC CHOLECYSTECTOMY

2021 ◽  
Vol 9 (02) ◽  
pp. 883-892
Author(s):  
Hp Singh ◽  
◽  
Naveen Kumar Jindal ◽  
Jaspreet Singh ◽  
◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Sedation Score ◽  
P Value ◽  
Randomised Study ◽  
The Past ◽  
Opioid Drugs ◽  
Elective Laparoscopic Cholecystectomy ◽  
Group B ◽  
Induction Of Anaesthesia ◽  
Made In

Background:-Numerous attempts have been made in the past to attenuate the haemodynamic responses occurring during laparoscopic cholecystectomy. The present study compared the effect of three opioids namely TRAMADOL, Fentanyl and Nalbuphine in obtundation of haemodynamic responses in laparoscopic cholecystectomy in terms of Heart rate, BP (SBP, DBP and MAP) and secondary aim was to calculate duration of analgesia and sedation score. Materials And Methods:-This was a randomised study comparing three opioid drugs- nalbuphine, fentanyl and TRAMADOL. It was carried out on 75 patients of either sex aged 18 - 60 years scheduled for elective laparoscopic cholecystectomy under GA. Subjects were enrolled into three groups- Group B (n= 25) patients received inj. TRAMADOL 2 mcg/kg IV, Group F (n= 25) received inj. Fentanyl 2 mcg/kg IV and Group N (n= 25) patients received inj. Nalbuphine 0.2 mg/kg 5 minutes before the induction. Result:-At the time of extubation, mean MAP in Group B, F and N was 99.88, 95.32 and 97.24 respectively. This difference is highly significant when compared statistically (p value is 0.005). Conclusion:-With this study, we conclude that the administration of intravenous fentanyl and nalbuphine five minutes prior to induction of anaesthesia helps in better obtundation of haemodynamic responses to laparoscopic cholecystectomy than TRAMADOL.

scholarly journals LAPAROSCOPIC CHOLECYSTECTOMY

2018 ◽  
Vol 25 (10) ◽  
pp. 1503-1509
Author(s):  
Mudassar Jabeen ◽  
Bushra Jamil ◽  
Shehzad Amjad Khan
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Operative Time ◽  
Standard Procedure ◽  
P Value ◽  
Randomized Controlled ◽  
Surgeon Experience ◽  
Widespread Acceptance ◽  
Group A ◽  
Elective Laparoscopic Cholecystectomy ◽  
Group B

Introduction: Since the first laparoscopic cholecystectomy (LC) was reportedin 1990, it has widespread acceptance as a standard procedure using four trocars. The fourth(lateral) trocar is used to grasp the fundus of the gall bladder to expose calot`s triangle. Withincreasing surgeon experience, LC has undergone many refinements including reductionin port number and size. Three port LC has been reported to be safe and feasible in manyclinical trials. Objectives: To compare the operative time and of three ports versus four portlaparoscopic cholecystectomy. Study Design: Randomized Controlled Trials. Setting: SurgicalDepartments, Allied & Civil Hospitals Faisalabad. Period: 15-09-2010 to 15-03-2011. Materialand Methods: 132 Patients who underwent elective laparoscopic cholecystectomy wererandomized to undergo either the 4-port. (Group A) or the 3-port LC (group B).66 patients ineach group. Results: Mean Operative time was 25.14±4.19 minutes in group A and 25.35±4.34in group B. (p value-0.774). Mean VAS score at 12th postoperative hour was 5.37±0.993 ingroup A and 4.52±0.986 in group B. (p value <0.0001). Conclusion: Three port Laparoscopiccholecystectomy did not affect, operative time. However it resulted in less early postoperativepain in three port LC.

scholarly journals Comparison of Bupivacaine injection versus normal saline in port sites & intraperitoneal spray for postoperative pain in laparoscopic cholecystectomy.

2021 ◽  
Vol 28 (7) ◽  
pp. 1028-1032
Author(s):  
Syed Mehmood Ali ◽  
◽  
Hajra Shuja ◽  
Mehak Adil ◽  
Sadaf Bokhari ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Normal Saline ◽  
Controlled Trial ◽  
Test Sample ◽  
Operational Definition ◽  
T Test ◽  
P Value ◽  
Group A ◽  
Elective Laparoscopic Cholecystectomy ◽  
Group B

Objective: To compare mean pain using bupivacaine injection versus normal saline in port sites & intraperitoneal spray in laparoscopic cholecystectomy. Study Design: Randomized Controlled Trial. Setting: Department of Anesthesia, Shaikh Zayed Hospital, Lahore. Period: October 2, 2018 to April 2, 2019. Material & Methods: Laparoscopic cholecystectomy patients were allocated to obtain either bupivacaine 0.25% or regular saline (N / S) randomly by lottery method. In bupivacaine group-A, 15ml 8of 0.25% bupivacaine spray on gall bladder bed, dissection surface and in ports area after surgery. In normal saline group-B received 15 ml of normal saline in the same area and ports after surgery. Pain was measured on VAS as per operational definition. All the data was entered with SPSS v25.0 and analyzed. A t-test study was used to evaluate the mean pain for both groups at 24th hours. In order to address the effect modifiers, the data was stratified for age, gender, and BMI (obese, non-obese). The independent t-test sample after stratification was used taking p-value 0.05 as relevant. Results: A total of 60 patients were included for elective laparoscopic cholecystectomy. In group-A, mean pain score was 3.33±0.81 and 4.37±1.16 in group-B, which is statistically significant with a p-value of 0.0002. Conclusion: This study demonstrates that bupivacaine spray at the surgical bed and in ports site in elective laparoscopic cholecystectomy result in significant lowering of the intensity of postoperative abdominal and shoulder pain.

Comparison of effect of Various Combinations of four drugs i.e IV Ondansetron, Ranitidine, Metoclopramide and Omeprazole, to reduce Gastric Fluid Residual Volume and Gastric Acidity in Elective Laparoscopic-Cholecystectomy patients

2021 ◽  
Vol 15 (7) ◽  
pp. 1760-1763
Author(s):  
Riffat Saeed ◽  
Irfan Ali ◽  
Iram Qamar ◽  
Syed Mehmood Ali ◽  
Amer Latif ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gastric Acidity ◽  
Gastric Fluid ◽  
P Value ◽  
Residual Volume ◽  
Significant Difference ◽  
Group A ◽  
Elective Laparoscopic Cholecystectomy ◽  
Group B ◽  
Group D

Background: Inhaling of gastric contents in lower respiratory tract and larynx results in developing of pulmonary aspiration. The acidity of aspirate contents and its volume determines severity of aspiration and is major cause of post-anesthetic mortality. Objective: To compare the effect of four drugs (ranitidine, IV ondansetron, metoclopramide, omeprazole and metoclopramide) in all possible four combinations, to decrease gastric fluid residual volume and gastric acidity in undergoing laparoscopic-cholecystectomy. Design: It was a clinical randomized trial. Study Settings: Trial was conducted at Department of Anesthesiology and ICU, Sheikh Zayed Hospital, Lahore, for a period of 6 months from 01-07-2019 to 31-12-2019. Patients and Methods: A total of 308 patients from both the genders undergoing laparoscopic cholecystectomy were included in this study. Four equal groups were made by random division of patients. Group A: ranitidine & ondansetron, group B: ranitidine & metoclopramide, group C: omeprazole & ondansetron and group D: omeprazole & metoclopramide. Pre-anesthetic medicine was given to all the patients two hours before surgery. For assessing volume of gastric fluid and its pH, an oro-gastric tube was passed. An informed written informed consent was taken from all the patients. Results: Mean age in this study was 36.40±9.15, 33.23±9.13, 36.82±9.37 and 36.57±9.49 years respectively for Group A,B,C and D. Aspirate had mean quantity of 12.56±5.60 ml/kg, 12.65±5.39 ml / kg, 13.68±5.76 ml/kg and 14.34±6.85 ml/kg and he aspirate mean pH was 2.56±0.55, 2.47±0.58, 2.51±0.57 and 2.45±0.58 respectively for group A,B,C and D. Among both the trial groups, this different was insignificant (p-value > 0.05) for both outcomes. Conclusion: All the drug combinations had no significant difference. However, comparatively less pH and volume of gastric fluid was shown by combination of ranitidine plus ondansetron. Therefore, this combination is recommended before general anesthesia for reducing gastric fluid aspirate in patients undergoing surgery. Keywords: Laparoscopic cholecystectomy, Omeprazole, Ranitidine, Metoclopramide, Ondansetron, gastric fluid acidity, pH, gastric fluid volume

Pregabalin As A Premedicant To Attenuate Pressor Response In Patients Undergoing Laparoscopic Cholecystectomy: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study

2020 ◽  
Vol 11 (3) ◽  
pp. 3418-3423
Author(s):  
Sweety Agrawal ◽  
Shubdha Bhagat ◽  
Pratibha Deshmukh ◽  
Amol Singham
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Pressor Response ◽  
Controlled Study ◽  
Double Blind ◽  
Co2 Insufflation ◽  
Ramsay Sedation Scale ◽  
Minute Interval ◽  
Group A ◽  
Group B ◽  
Induction Of Anaesthesia

The present study was done to evaluate the ability of oral pregabalin to attenuate the pressor response to airway instrumentation in patients undergoing laparoscopic cholecystectomy under general anesthesia. Sixty-four adult patients aged between 25-55 year of either gender belonging to ASA-1 or ASA2 physical status weighing 50-70 kg were enrolled in this study. Thirty-two patients each were randomized to group A, or group B. Patients in group A received tablet Pregabalin (150mg) and those in group B received placebo orally one hour before induction of anaesthesia. Heart rate, blood pressure, and sedation were assessed preoperatively before giving the tablets and after 30 minutes, and just before induction of anaesthesia. Intraoperative, pulse rate, mean arterial pressure, ECG in the lead II, SPO2 and ETCO2 were monitored. All the above parameters were noted during laryngoscopy and intubation, 3 minutes after CO2 insufflation, and then at every 10-minute interval till the end of surgery. These parameters were also recorded after extubating the patient. The Ramsay sedation scale was used to assess the sedation at the baseline, one hour after drug intake , one hour after extubation and 4 hour after surgery. Any adverse effects in the postoperative period were recorded. The result of our study shows that pre-emptive administration of oral pregabalin 150 mg significantly reduced the pressor response at the time of laryngoscopy and intubation, after CO2 insufflation and just after extubation. We conclude that oral pregabalin premedication is effective in successful attenuation of hemodynamic pressor response to laryngoscopy, intubation and pneumoperitoneum in patients undergoing laparoscopic cholecystectomy

scholarly journals LAPAROSCOPIC CHOLECYSTECTOMY;

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.

scholarly journals ANTIBIOTIC PROPHYLAXIS IN LAPAROSCOPIC CHOLECISTECTOMY: IS IT WORTH DOING?

2016 ◽  
Vol 29 (3) ◽  
pp. 170-172 ◽  
Author(s):  
Márcio Alexandre Terra PASSOS ◽  
Pedro Eder PORTARI-FILHO
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Antibiotic Prophylaxis ◽  
Infectious Complications ◽  
Low Risk ◽  
Double Blind Study ◽  
Significant Difference ◽  
Risk Patients ◽  
Group A ◽  
Elective Laparoscopic Cholecystectomy ◽  
Group B

ABSTRACT Background: Elective laparoscopic cholecystectomy has very low risk for infectious complications, ranging the infection rate from 0.4% to 1.1%. Many surgeons still use routine antibiotic prophylaxis Aim: Evaluate the real impact of antibiotic prophylaxis in elective laparoscopic cholecystectomies in low risk patients. Method: Prospective, randomized and double-blind study. Were evaluated 100 patients that underwent elective laparoscopic cholecystectomy divided in two groups: group A (n=50), patients that received prophylaxis using intravenous Cephazolin (2 g) during anesthetic induction and group B (n=50), patients that didn't receive any antibiotic prophylaxis. The outcome evaluated were infeccious complications at surgical site. The patients were reviewed seven and 30 days after surgery. Results: There was incidence of 2% in infection complications in group A and 2% in group B. There was no statistical significant difference of infectious complications (p=0,05) between the groups. The groups were homogeneous and comparable. Conclusion: The use of the antibiotic prophylaxis in laparoscopic cholecystectomy in low risk patients doesn't provide any significant benefit in the decrease of surgical wound infection.

scholarly journals Comparison of laparoscopic cholecystectomy using harmonic scalpel with conventional laparoscopic cholecystectomy in patients of symptomatic gallstones.

2020 ◽  
Vol 27 (10) ◽  
pp. 2050-2055
Author(s):  
Muhammad Asif ◽  
Muhammad Faheem Anwer ◽  
Muhammad Hasan Anwaar ◽  
Shahbaz Ahmad ◽  
Muhammad Kamran ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Blood Loss ◽  
Operative Time ◽  
Harmonic Scalpel ◽  
Conventional Group ◽  
P Value ◽  
Conventional Laparoscopic Cholecystectomy ◽  
Conventional Laparoscopic ◽  
Symptomatic Gallstones ◽  
Group B

Objectives: To compare the laparoscopic cholecystectomy using harmonic scalpel with conventional laparoscopic cholecystectomy in patients of symptomatic gallstones in terms of mean operative time and mean intra-operative blood loss. Study Design: Randomized Control trial. Setting: Department of Surgical at Allied Hospital Faisalabad. Period: 6 months Oct 2017 to Mar 2018. Material & Methods: Eighty (80) patients (forty in one group) divided randomly into A (harmonic scalpel group) and B (conventional) group, done under general anesthesia. Total time of operation and blood loss during procedure was noted. Results: Our study showed that mean operative time in Harmonic group (A) was 38.07+5.28 minutes and in Conventional group (B) 63.75+7.62 minutes, (p-value = 0.0001), blood loss in Harmonic group (A) 32.93+8.86ml and 55.53+8.96ml in Conventional group (B), (p-value = 0.0001). Conclusion: It is concluded that the laparoscopic cholecystectomy using harmonic scalpel is significantly better when compared with conventional laparoscopic cholecystectomy in patients of symptomatic gallstones in terms of mean operative time and mean intra-operative blood loss.

scholarly journals Comparative Study of Oral Clonidine and Midazolam as Premedication in Pediatric Patients Undergoing Tonsillectomy

2019 ◽  
Vol 4 (1) ◽  
Keyword(s):  
Statistical Significance ◽  
Anxiety Score ◽  
P Value ◽  
Parental Separation ◽  
Oral Clonidine ◽  
Oral Midazolam ◽  
Group A ◽  
Group B ◽  
Double Blinded ◽  
Induction Of Anaesthesia

Background and Aim: Anxiety and fear of operation, injections, physicians, operation theatre environment and parental separation are all traumatizing experiences in children. The aim of the study was to compare the effects of oral midazolam and oral clonidine as premedication in children undergoing tonsillectomy .The preoperative sedation, anxiolytic, acceptance of mask for induction of anaesthesia, intravenous cannulation and post-operative recoverywere assessed in both groups. Methods: Aprospective randomized double blinded study of 100 patients of age group 4 -12 yrs undergoing tonsillectomy under general anaesthesia were selected. They were divided into 2 groups of 50 patients each. Group A (oral clonidine) received 4 mcg/kg 90 minutes before induction. Group B (oral midazolam) received 0.5 mg/kg 90 minutes before induction. The sedation and anxiety score was noted at the time of parental separation. The reaction to IV cannulation was assessed by sedation and anxiety scoring at the same time all of them were taken under GA with controlled ventilation. The Mask acceptance was graded by 5 point scoring system .Grade 3,4 and 5 are satisfactory.They were monitored throughout the surgery for any complications. Post operative status was assessed by Modified Objective Pain score. Results: The sedation score and anxiety score at venipuncture was better with clonidine group with statistical significance (p< 0.000 and<0.003). The mask acceptance was better with clonidine group with statistical significance (p <0.000).Postoperative score was also better with clonidine group with statistical significance of p value <0.000. Conclusion: We concluded that oral clonidine and midazolam can be used as better premedicants to produce optimal sedation and emotional state.Clonidine 4 μg / kg has been shown to be a more effective premedication for children undergoing elective tonsillectomy than midazolam 0.5mg/kg

scholarly journals Comparison of standard and low-pressure pneumoperitoneum; reduction in frequency and intensity of post-operative shoulder pain

2019 ◽  
Vol 2 (2) ◽  
pp. 47-51
Author(s):  
Sania Waseem ◽  
Humera Naz Altaf ◽  
Sehrish Latif ◽  
Omar Shahzad Altaf ◽  
Fareeha Farooqui ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Abdominal Cavity ◽  
Low Pressure ◽  
Intraabdominal Pressure ◽  
P Value ◽  
Reduced Pressure ◽  
Quasi Experimental ◽  
Group A ◽  
Standard Pressure ◽  
Group B

Laparoscopic cholecystectomy is now gold standard and depends on good exposure of the peritoneal cavity. It is achieved by insufflation of the abdominal cavity with CO2. Operating at lower intraabdominal pressure (<12 -15mmHg) has been associated with fewer pulmonary and hemodynamic complications and lesser postoperative pain. Objective: To ascertain the advantages of low pressure pneumoperitoneum over standard pressure pneumoperitoneum Methods: Our study was quasi experimental study conducted at  KRL Hospital, Islamabad over period of 3years from 2013 to 2016. SPSS version 20 was used to calculate p value.  Results: A total of 456 patients of gallstones were equally divided in two groups assigned to undergo low pressure (7-8mm of Hg) pneumoperitoneum or standard pressure (12-14mm of Hg) pneumoperitoneum laparoscopic cholecystectomy The average age of patients was 46.2+/-13.6yrs in group A compared to 43.5 +/- 12.9 in group B. There were 60 (26.3%) male and 168 (73.7%) female patients in group A compared to 53 (23.2% and 175 (76.85) in group B respectively. It was found that group A 14 (6.1%) had no pain, 26 (11.4%) had VAS between 1 – 7 and 188 (82.5%) had VAS of 8 – 10 where as in group B 164 (72.6%) patients reported no shoulder tip pain postoperatively, 42 (18.6%) had VAS of 1 – 7 and 20 (8.8%) had VAS OF 8 – 10. The difference was statistically significant (p-value = <0.001). Conclusions: reduced pressure of pneumoperitoneum to 7 – 8 mm of Hg produce lower incidence of postoperative shoulder tip pain.

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