scholarly journals Comparison of intraincisional and intraperitoneal infiltration of local anaesthetic in laparoscopic cholecystectomy to control early postoperative pain.

2021 ◽  
Vol 28 (02) ◽  
pp. 192-196
Author(s):  
Nadia Bano ◽  
Nazim Hayat ◽  
Saira Saleem ◽  
Farhan Javaid ◽  
Ayesha Rehman ◽  
...  

Objective: To compare the effects of intraincisional and intraperitoneal infiltration of local anaesthetic to relieve early postoperative pain in laparoscopic cholecystectomy. Study Design: Randomized Control Trial. Setting: Department of Anaesthesia and Surgery, Madinah Teaching Hospital Faisalabad. Period: July 2017 to March 2018. Material & Methods: A sample of 100 patients with American Society of Anaesthesiologists Physical status (ASA) I and II, undergoing laparoscopic cholecystectomy were selected using simple random sampling technique. Patients were randomly assigned into groups A and B. Group A patients received intraperitoneal infiltration of 20 ml solution of 0.25% bupivacaine and group B patients received intraincisional infiltration of 20 ml solution of 0.25% bupivacaine. Results:  Demographic characteristics were not significantly different in both groups. Our study showed that Group A patients had better pain relief as compared to group B patients. Visual analogue score (VAS) for pain relief at 0, 3,6,12 and 24 hours was statistically different in both groups. The requirement of rescue analgesia between group A and B was found to be12% and 38% which is statically significant (p value 0.003). Conclusion: intraperitoneal infiltration of Bupivacaine offers better postoperative pain relief after laparoscopic cholecystectomy and is associated with less analgesic requirement in early postoperative period.

2021 ◽  
Vol 15 (10) ◽  
pp. 2622-2624
Author(s):  
Haq dad Durrani ◽  
Rafia Kousar ◽  
Ejaz Iqbal ◽  
Muhammad Abdul Aziz ◽  
Syed Aushtar Abbas Naqvi ◽  
...  

Background: Pain is the most common and most difficult problem faced by patients after operation. Due to inadequate management 30-70% patients suffer from post-operative pain. Acute pain resulting in chronic pain reduces quality of life and creates economic burden. Aim: To compare post-operative pain relief between infiltration of 0.25% bupivacaine into skin and subcutaneous tissue in the line of incision before incision and along edges of wound near completion of procedure. Study design: Randomized control trial Methodology: Sixty four patients were randomly divided into two groups i.e. (0.25% Bupivacaine 6 to 30ml) at the site of incision into skin and subcutaneous tissue Preincision (Group P) and (0.25% Bupivacaine 6 to 30ml) along the edges of wound at near closure of procedure (Group C). Intensity of pain was assessed on visual analogue scale in the recovery room, 3, 6 and 24 hours postoperatively.The time of first dose of rescue analgesia within 24 hours was also noted in both groups. Results: There was no statistically significant difference between two groups regarding age (p-value = 0.324), gender i.e. males (p=0.545) females (p=0.763) and duration of operation (P=Value=0.208). The mean time of rescue analgesia in Group P and Group C in minutes was 318.12±149.47 and 374.84±125.67 respectively (p value =1.5) reflecting no statistically significant difference. Conclusion: Postoperative analgesia and analgesic requirement do not differ significantly whether bupivacaine is infiltrated before incision or just before closure of wound. Keywords: Postoperative pain, bupivacaine, rescue analgesia, Preincision


2016 ◽  
Vol 3 (2) ◽  
pp. 41 ◽  
Author(s):  
Mahesh Sharma ◽  
Kalpana Kharbuja ◽  
Nil Raj Sharma

Introduction: Laparoscopic cholecystectomy has been the gold standard in the treatment of gallstones since last decades. Beside several benefits of laparoscopic cholecystectomy compared with open surgery, postoperative pain is still a frequent melancholy.  Hence, pain management is utmost regarding patients' comfort. The main objective of the study was to compare the effect of intraperitoneal hydrocortisone plus bupivacaine with bupivacaine alone on pain relief following laparoscopic cholecystectomy.   Methods: A randomized study was conducted from December 2015 to August 2015 that included 100 patients aged 20 to 60 years of both genders who were found to have symptomatic gallstones and were scheduled for elective laparoscopic cholecystectomy at Lumbini Medical College. Patients randomly received 100 mg hydrocortisone plus 100 mg bupivacaine in 200 ml normal saline (group A) or 100 mg bupivacaine in 200 ml normal saline (group B) into the peritoneum. Post-operative abdominal and shoulder pain were evaluated using Visual Analog Score (VAS). The patients were also followed up for postoperative analgesic requirements, and recovery variables. Data were collected, tabulated and analyzed statistically using SPSS version 19.   Results: Total number of patients in this study were 100. Age and gender among both groups were comparable. VAS scores for pain was significantly lower for group A as compared to group B at 0, 2, 4, 6, 12, and 24 hours. Time of oral intake in hrs for liquids and solids was statistically significant in Group A compared to Group B. Rescue analgesic requirement was also significantly low in Group A compared to Group B. Hospital stay in both group were comparable.   Conclusion: Combination of hydrocortisone plus bupivacaine can relieve pain after laparoscopic cholecystectomy better compared to bupivacaine alone when administered intraperitoneally.


2021 ◽  
pp. 13-15
Author(s):  
Debottam Gangopadhyay ◽  
Rahul Agarwal

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.


2021 ◽  
Vol 23 (05) ◽  
pp. 421-432
Author(s):  
Dr. Mohammad Kheiri Mahmod ◽  
◽  
Dr. Bashar Naser Hussein ◽  
Dr. Ammar Hamid Hanoosh ◽  
◽  
...  

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.


2017 ◽  
Vol 24 (07) ◽  
pp. 1062-1066
Author(s):  
Bashir Ahmed ◽  
Hamid Raza ◽  
Kamlaish -

Objectives: The aim of our study which is to compare total intravenousanesthesia with target controlled infusion using the drugs Propofol and remifenatnil with thetechniques of volatile induction maintenance anesthesia using sevoflurane and sufentanil inpatients undergoing laparoscopic cholecystectomy procedure, at a tertiary care hospital inKarachi, Pakistan. Study Design: The type of study is a randomized control trial, conductedfor a period of 8 months Period: from June 2015 to January 2016 Setting: at a tertiary carehospital in Karachi Pakistan. Method: The patient population consisted of n=100 patientsbelonging to the ASA class I and II and undergoing laparoscopic cholecystectomy procedure atour institute. The patients were divided into two groups group A consisted of all those patientswho underwent total intravenous anesthesia and group B consisted of patients who underwentvolatile induction maintenance anesthesia. Appropriate blinding measures were taken for thosewho were involved in the post-operative care of the patients, and the patients themselves. Duringthe procedure routine monitoring was done, data was recorded in a pre-designed proforma.Patients were analyzed in the post-operative period for side effects and pain levels. Statisticalanalysis was done using SPSS version 23, a p value of less than 0.05 was considered to bestatistically significant. Results: The patient population consisted of n= 100 patients dividedinto two groups. No statistically significant difference was found between the demographicvariables of the patients of both groups (age, weight, baseline values of blood pressure, heartrate, time duration of surgery and anesthesia). The time for the loss of corneal reflex was longerin the group A (109 +/- 90) as compared to group B (45 +/- 10) having a p value of less than0.001. However the time for opening of the eyes and the duration of post anesthesia care unitwas shorter in group A (420 +/- 130 seconds for eye opening and 45 +/- 15 min for PACU) andin group B (484 +/- 116 seconds for eye opening and 53 +/- 25 mins for PACU) having p valuesof 0.006 (eye opening) and 0.017 (PACU) respectively. In group A n= 44 (88%) of the patientsrequired rescue analgesia, and in group B n= 36 (72%) of the patients required it, having a pvalue of 0.013 respectively. The need for the use of ephedrine and atropine in the pre and portoperative period was similar in both the groups. Conclusion: According to the results of ourstudy we found that each method of anesthesia has its own advantages and disadvantagesand the anesthetist present should weigh the risks and benefits for each patient individually,and use the most beneficial method of administration of anesthesia in the patient undergoinglaparoscopic cholecystectomy procedure, accordingly.


2019 ◽  
Vol 8 (1) ◽  
pp. 29-33
Author(s):  
Tabish Hussain ◽  
Asifa Anwar Mir ◽  
Jawad Zahir ◽  
Pervaiz Minhas

Background: Postoperative pain creates complications by increasing circulating level of catecholamines and systemic vascular resistance, thus putting the patients on increased risks of having stroke and myocardial infarction. In addition, it increases hospital stay, causing burden over economic as well as healthcare infrastructure. The aim of this study was to determine the frequency of pain in the postoperative period while using Pregabalin as pre-medication among patients undergoing laparoscopic cholecystectomy.Material and Methods: The randomized control trail was conducted at Department of Anesthesiology, Holy Family hospital, Rawalpindi from 1st Sept 2015 to 28th Feb 2016 over a period of 6 months. A total of 200 patients undergoing laparoscopic cholecystectomy were randomly divided in group A and B by consecutive non-probability lottery method. Group A received 100 mg oral Pregabalin 1 hour before surgery and Group B were not given Pregabalin and were taken as controls. Post-operative pain was measured by visual analog scale (VAS) in terms of pain scores at 4 hours postoperatively after the arrival of patient in the post-anesthesia care unit (PACU). SPSS version 17.0 was used to analyze the data.Results: A total of 200 patients were included in the study. There were 100 patients in each group. Based on the visual analog pain scores, 9 patients were pain free in group A compared with none in group B. Similarly, there were 55 patients in group A, who reported a pain score of 1 whereas no patient in group B had a VAS score of 1. There were 29 patients in group A and only 3 patients in group B with VAS score of 2 (90.6% vs. 9.4%). For VAS score of 3, there were 6 patients in group A and 34 patients from group B (15% vs. 85%). For a VAS score of 4, there were 1 patient in group A and 61 patients in group B (1.6% vs. 98.4%). Two patients in group B experienced a VAS score of 5. All this data was significant with chi square p value of 0.0001.Conclusion: Oral Pregabalin administered prior to laparoscopic cholecystectomy was effective in reducing postoperative pain in the patients. Further studies are needed for post-operative evaluation of side effects, different dosing schedules at different time intervals for both rest and dynamic pain.


Author(s):  
Varun Kumar Singh ◽  
Sofia Batool ◽  
Babita Chettri ◽  
Kumar Nishant ◽  
Wali Ahmad

Introduction: Even though Laparoscopic Cholecystectomy (LC) is far less traumatic compared to open cholecystectomy, it is still associated with considerable postoperative pain. Apart from routine analgesics, several attempts have been made to establish intraperitoneal analgesia as a useful perioperative pain relief modality. Aim: To determine the optimal concentration (or dilution) and volume of intraperitoneal lignocaine among three preparations of 100 mg lignocaine for postoperative analgesia after LC. Materials and Methods: Study was designed as a randomised controlled, double blinded study. Patients undergoing elective LC for symptomatic cholelithiasis were included in the study. Patients (n=105) were randomised into three groups. Group A received 5 mL 2% lignocaine in 5 mL normal saline (100 mg/10 mL=10 mL solution of 1% lignocaine). Group B received 5 mL 2% lignocaine in 100 mL of normal saline (100 mg/100 mL=100 mL solution of 0.1% lignocaine). Group C received 5 mL 2% lignocaine in 500 mL normal saline (100 mg/500 mL=500 mL solution of 0.02% lignocaine). Three groups were compared for postoperative pain using Visual Analog Score (VAS), requirement of rescue analgesia, nausea and vomiting, vital parameters (heart rate, respiratory rate, mean arterial pressure, transcutaneous saturation) and hospital stay. Analysis of Variance (ANOVA) was used to compare mean and χ2 test was used to compare categorical data. Results: The mean VAS of group B (100 mg lignocaine in 100 mL of normal saline) was significantly lower than the overall mean VAS at different postoperative time intervals, and consistently lower than those of groups A and C. The study found a consistent (r=0.15 to 0.33) and significant (p<0.05 at all-time intervals) positive correlation between pain and duration of surgery. Demand for rescue analgesia was significantly higher in group A. Pulse rate was least in all postoperative time and significantly lower at 4th hour. The difference in mean arterial pressures, respiratory rate and transcutaneous saturation among the three groups was not significant statistically. Nausea and vomiting were uncommon. Conclusion: The study concluded that for a total dose of 100 mg lignocaine, 100 mL solution is more effective compared to 10 mL or 500 mL solution.


PRILOZI ◽  
2018 ◽  
Vol 39 (1) ◽  
pp. 123-129 ◽  
Author(s):  
Marija Toleska ◽  
Andrijan Kartalov ◽  
Biljana Kuzmanovska ◽  
Milcho Panovski ◽  
Mirjana Shosholcheva ◽  
...  

Abstract Introduction: Patients undergoing laparoscopic cholecystectomy do experience postoperative pain, especially in the abdomen. Postoperative pain management remains a major challenge after laparoscopic procedures. Administration of intraperitoneal local anesthetic (IPLA) after surgery is used as a method of reducing postoperative pain. In this study, we evaluated the effect of intraperitoneal infiltration of local anesthetic (bupivacaine) for pain relief after laparoscopic cholecystectomy. Material and methods: In this prospective, controlled, and randomized study were included 50 patients aged 25-60 years (35 female and 15 male), scheduled to laparoscopic cholecystectomy with ASA classification 1 and 2. Patients were classified randomly into two groups: group A, which included 25 patients who received intraperitoneal instillation of bupivacaine 0.5% 20 ml; and group B, which included 25 patients who didn’t receive any intraperitoneal instillation. Postoperative pain was recorded using the visual analogue scale (VAS) for 24 hours after laparoscopic cholecystectomy. Results: There was no significant difference with respect to age, weight, and sex; duration of surgery; and anesthesia time. VAS scores at different time intervals were statistically significantly lower at all times in group A compared to group B. There were statistically significant differences in VAS scores between group A and group B at all postoperative time points - 1hr,4 hr,8 hr,12hr and 24hr (p < 0.00001). Conclusion: Intraperitoneal instillation of bupivacaine provides good analgesia in the postoperative period after laparoscopic cholecystectomy.


2020 ◽  
pp. 4-6
Author(s):  
Siddharth Singh ◽  
Ramendra Kumar Jauhari ◽  
Yukteshwar Mishra ◽  
Sanjay Kumar Singh ◽  
Adiveeth Deb

Background: Intraperitoneal instillation of local anesthetic agents in laparoscopic cholecystectomy (LC) has been used to reduce postoperative pain and to decrease the need for postoperative analgesia. Aims: This study aimed to evaluate the effectiveness of intraperitoneal instillation of bupivacaine (0.25%) for post operative analgesia in LC. Settings and Design: This was a prospective, randomized, single blind study. Materials and Methods: After obtaining ethical committee’s clearance and informed consent, 204 patients, aged 18–80 years, of either gender, and scheduled for LC were included and categorized into two groups (n = 102). Group A patients received 20 mL of 0.25% bupivacaine intraperitoneally, as well as at trocar site, after cholecystectomy, and Group B patients received the drug only at trocar site. Statistical Analysis: The data were analyzed using paired t test. The results were analyzed and compared to previous studies. SPSS software version 22 was used, released 2013 (IBM Corp., Armonk, NY, USA). Results: The Numerical Rating Scale (NRS) score was significantly lower in Group A for the first 8 hours post operatively. Rescue analgesia was given when NRS was more than or 5. Rescue analgesic requirement was also less in Group A for the first 8 hours. Conclusion: The instillation of bupivacaine intraperitoneally is an effective method of postoperative pain relief in LC. It provided good analgesia in the early postoperative period. Requirement of rescue analgesics was also decreased.


2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
H Anwaar ◽  
R Ahmed ◽  
Z Hashmi ◽  
Q Qavi ◽  
T Zafar

Abstract Introduction Recent studies have shown that patients may experience considerable pain after laparoscopic cholecystectomy as well. Hence, this study was done to compare results on post op pain with low pressure pneumoperitoneum compared with standard pneumoperitoneum. Method 100 patients were selected for study and equally divided in two groups randomized into Low pressure (n = 50) and Standard pressure (n = 50). Operative time (min), postoperative pain (VAS) and frequency of Shoulder Tip Pain was noted in both groups Results A total of 100 patients were enrolled for this study. Patients were divided into two groups i.e. Group-A (Standard pressure) and Group-B (Low pressure). In group-A, there were 35(70%) males and 15(30%) females, while in group-B, there were 41(82%) males and 9(18%) females. Mean age of group-A patients was 42.0±7.0 years and 44.5±8.1 years in group-B. In group-A, 18(36%) patients had shoulder tip pain, while 4(8%) patients had had shoulder tip pain in group-B patients with a p-value of 0.001, which is statistically significant. Conclusions Laparoscopic cholecystectomy using low pressure pneumoperitoneum is feasible and results in less post-operative shoulder tip pain.


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