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

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.

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COMPARISON OF ONDANSETRON AND METOCLOPRAMIDE IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY UNDER GENERAL ANESTHESIA.

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.07.3825 ◽

2019 ◽

Vol 26 (07) ◽

pp. 1197-1202

Author(s):

Hajra Shuja ◽

Mehmood Ali Shah ◽

Sadaf Bokhari

Keyword(s):

Laparoscopic Cholecystectomy ◽

General Anesthesia ◽

Controlled Trial ◽

Study Groups ◽

P Value ◽

Significant Difference ◽

High Incidence ◽

Group A ◽

Group B ◽

Trial Setting

Background: Laparoscopic cholecystectomy is a standard treatment for cholelithiasis. It is a safe and effective treatment in many cases. General anesthesia has a high incidence for PONV. But anti-emetic drugs can help in preventing PONV. Objectives: To compare the efficacy of ondansetron and metoclopramide in patients undergoing laparoscopic cholecystectomy under general anesthesia. Study Design: Randomized controlled trial. Setting: Department of Anaesthesia, Sheikh Zayed Hospital, Lahore. Period: 6 months i.e. from 15-2-2017 to 15-8-2017. Material & Methods: The patients were divided into two groups. Ondansetron was given to group A patients within 15 minutes of induction, and metoclopramide to group B patients within 15 minutes of induction. Then patients were shifted to the ward after surgery and followed-up for 24 hours for assessment of PONV. All the data was entered and analyzed on SPSS version 20. Results: The mean age of patients in group A was 38.40±12.07 years and in group B was 42.63±11.77 years. The efficacy achieved in 53 were from group A and 39 were from group B Statistically significant difference was found between the study groups i.e. p-value=0.003. Conclusion: Ondansetron showed significantly better efficacy than metoclopramide in preventing PONV after laparoscopic cholecystectomy under general anesthesia.

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Comparative study showing relevance of prosthesis diameter and hearing outcome in stapes surgery

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20203196 ◽

2020 ◽

Vol 6 (8) ◽

pp. 1464

Author(s):

Udayanila Thangavel ◽

Harish Narasing Katakdhond ◽

Deepak Dalmia ◽

Narsinha Davange ◽

Parth Patni ◽

...

Keyword(s):

Controlled Trial ◽

T Test ◽

P Value ◽

Hearing Improvement ◽

Hearing Outcome ◽

Teflon Piston ◽

Significant Difference ◽

Group A ◽

Group B ◽

The Individual

Background: Otosclerosis presents as conductive hearing loss, stapedotomy is the treatment for otosclerosis, and different sizes of piston diameter are available for the procedure. Aims and objectives were to study and compare hearing improvement between the 0.4 and 0.6 mm sizes of teflon piston in stapedotomy.Methods: It was a prospective randomized controlled trial. Patients fulfilling inclusion criteria were subjected for small fenestra stapedotomy. Patients were divided into two groups after randomization into group A (with 0.4 mm piston diameter) and group B (with 0.6 mm piston diameter). The hearing outcome with standard audiological assessment was performed at one month and six months postoperatively. Results: Comparison of 1 month AB gap among the patients with 0.4 mm piston and 0.6 mm piston showed that there was no statistically significant difference among both the groups of patients (independent t test p value=0.699). Comparison of 6 month AB gap among the patients with 0.4 mm piston and 0.6 mm piston showed that there was no statistically significant difference among both the groups of patients (independent t test p value=0.54).Conclusions: There was no significant difference in hearing improvement among the individual methods (piston size 0.4 and 0.6) with each other both in 1 month post-operative and 6 month post-operative follow up. Hence, we conclude that there is no relevance of different diameter of teflon piston prosthesis (0.4 mm versus 0.6 mm) as far as hearing outcome is concerned.

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LAPAROSCOPIC CHOLECYSTECTOMY

The Professional Medical Journal ◽

10.29309/tpmj/18.4838 ◽

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.

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Comparison of Frequency of Surgical Site Infection with or without Bile Spillage during Laparoscopic Cholecystectomy

10.53350/pjmhs211561449 ◽

2021 ◽

Vol 15 (6) ◽

pp. 1449-1452

Author(s):

M. Asif ◽

L. A. Deokah ◽

R. N. Malik

Keyword(s):

Laparoscopic Cholecystectomy ◽

Surgical Site Infection ◽

Controlled Trial ◽

Operational Definition ◽

Study Group ◽

Site Infection ◽

Group A ◽

Group B ◽

Bile Spillage

Aim: To compare the frequency of surgical site infection with or without bile spillage during Laparoscopic Cholecystectomy. Methods: This randomized controlled trial was conducted at Department of Surgery, M. Islam Medical and Dental College Gujranwala from March 2020 to September 2020 over the period of 6 months. Total 68 pppatients of acute cholecystitis (as per operational definition) undergoing laparoscopic cholecystectomy either male or female having age from 20 60 years with duration of gal stone (single or multiple) ≥ 6 months were selected. After 2 weeks follow-up, surgical site infection was assed. Results: Mean age of the patients was 39.90 ± 12.04, mean age of patients of study group A was and B was 38.88 ± 13.01 and 40.91 ± 11.08 years respectively. Comparison of frequency of surgical site infection was done between both groups. In study group A (spillage group), SSI was found in 12 (35.29%) patients while in study group B (without spillage group), SSI was noted in 4 (11.76%) patients. Difference of frequency of SSI between the study group A and B was statistically significant (P = 0.022). Conclusion: Results of present study showed that surgical site infection is mostly occurred in patients with spillage of bile during Laparoscopic Cholecystectomy. Most of the patients were belonged to 3rd and 4th decade of life. Significantly higher rate of surgical site infection was noted in female patients of spillage of bile group. Keywords: Bile spillage, Laparoscopic Cholecystectomy, gall bladder, surgical site infection

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PROPHYLAXIS OF POSTOPERATIVE NAUSEA AND VOMITING LAPAROSCOPIC PROCEDURES WITH 5-HT3 RECEPTOR ANTAGONISTS, A RANDOMIZED CONTROLLED TRIAL.

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.07.3784 ◽

2019 ◽

Vol 26 (07) ◽

pp. 1131-1135

Author(s):

Maqsood Ahmed Siddiqui ◽

Ahmed Uddin Soomro ◽

Hamid Raza ◽

Kamlaish

Keyword(s):

Randomized Controlled Trial ◽

Normal Saline ◽

Controlled Trial ◽

Nausea And Vomiting ◽

P Value ◽

Randomized Controlled ◽

Risk Patients ◽

Group A ◽

Group B ◽

Post Operative Nausea

Objectives: In this study we aim to study the efficacy of Ramosetron and Palonosetron in preventing post-operative nausea and vomiting in high risk patients. Study Design: A randomized controlled trial. Setting: A Large Tertiary Care Centre in Karachi. Period: 9 months from January 2017 to September 2017. Method: N=81 participants took part in the study. The patient population was divided into three groups.. Patients belonging to group A received Palonosetron 0.075mg mixed with normal saline in a mixture of 3ml, prior to induction, and received 3ml of normal saline half an hour prior to the end of the procedure. Patients in group B received 3ml of normal saline prior to induction and a mixture of 0.3mg of Ramosetron mixed with normal saline as 3ml half an hour before end of procedure. In group C patients received normal saline 3ml both before induction and half an hour prior to end of surgery. Results: The patient demographics were similar in all the groups and no significant difference was found. The incidence of post-operative nausea and vomiting during 2 hours post operatively was 41.97%, the incidence of nausea at 2 hours was in group A= 33.33%, in group B= 29.62%, in group C= 62.96% respectively, having a p value of 0.014 refer to table 2. After 48 hours of surgery the overall incidence of vomiting in the groups was not significant having a p value of 0.428 and an incidence of 6.172%. Conclusion: Palonosetron and Ramosetron are equally effective in prevention of post-operative nausea and vomiting in high risk patients undergoing laparoscopic gynecological procedures.

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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

10.53350/pjmhs211571760 ◽

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

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COMPARISON OF EFFECTIVENESS OF MOBILIZATION AND SELF-EXERCISES IN ADHESIVE CAPSULITIS OF SHOULDER

Pakistan Journal of Rehabilitation ◽

10.36283/pjr.zu.7.1/004 ◽

2018 ◽

Vol 7 (1) ◽

pp. 35-41

Author(s):

Muhammad Usman Khan ◽

Ghazala Noor Nizami ◽

Ali Farhad

Keyword(s):

Pain Intensity ◽

Adhesive Capsulitis ◽

Descriptive Analysis ◽

Tertiary Care ◽

Sampling Technique ◽

Simple Random Sampling ◽

T Test ◽

P Value ◽

Group A ◽

Group B

OBJECTIVE To compare the effectiveness of mobilization and self-exercises in the management of adhesive capsulitis of shoulder STUDY DESIGN Randomized Control Trial SAMPLE SELECTION 30 patients of adhesive capsulitis of shoulder from physiotherapy department of tertiary care hospitals of Karachi were selected through simple random sampling technique. PROCEDURE Treatment was continued for 5 days per week for the period of 3 weeks followed by assessment. Patients were randomly divided into two equal groups. Group A was treated with midrange mobilization while group B performed self-exercises. Both groups received TENS and hot pack prior to the exercises. Mean ± SD, frequencies and percentages were used for descriptive analysis. ROM via goniometry and pain intensity through VAS was analyzed by paired t-test within the groups and by independent t-test between the groups, using SPSS. P-value of less than 0.05 was considered significant. RESULTS 60% were females (n=18) and 40% were males (n=12) with mean age of 50.17±6.37 years. Significant improvement (p-value <0.05) in pain and shoulder ROM was observed among patients of Group A as compared to Group B. Pain intensity was decreased to 1.67 ± 0.62 in group A, whereas ROMs in these patients were also better than other group.

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PRECIPITATING FACTORS AND EFFICACY OF COMBINING LACTULOSE PLUS RIFAXIMIN IN THE TREATMENT OF HEPATIC ENCEPHALOPATHY DUE TO CIRRHOSIS AT CHO RAY HOSPITAL

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2020.4.8 ◽

2020 ◽

pp. 63-68

Author(s):

Phat Ho Tan ◽

Tam Vu Thi Minh ◽

Trong Huynh Nguyen Dang ◽

Phuong Tran Nhat Thi Anh ◽

Ngan Tran Thi Kim ◽

...

Keyword(s):

Hepatic Encephalopathy ◽

Gastrointestinal Bleeding ◽

Clinical Symptoms ◽

Controlled Trial ◽

P Value ◽

Precipitating Factors ◽

Overt Hepatic Encephalopathy ◽

Group A ◽

Group B ◽

Male To Female

Background: Hepatic encephalopathy is an important evidence that confirms impairment of liver function, may occur in about 40% of cirrhotics. Data about efficacy of rifaximin plus lactulose in the treatment of Vietnamese patients was still limited. This study aimed to determine the precipitating factors and to access the efficacy of lactulose plus rifaximin in overt hepatic encephalopathy. Patients and Methods: The prospective single-blind randomized controlled trial, 43 cirrhotics with overt hepatic encephalopathy without portal systemic shunting addmitted to gastroenterology department of Cho Ray Hospital from March 2019 to August 2019, were randomized into two groups (group A lactulose plus rifaximin 1.100 mg/day, n = 21; and group B only lactulose; n = 22). All patients were recorded for onset factors, clinical characteristics and assessing the recovery of hepatic encephalopathy. Results: The mean age of patients in this study was 54.8 ± 12.1 years (the ratio of male to female patients is 4.38 : 1). The leading cause of cirrhosis was alcohol (39.5%). The most common clinical symptoms were jaundice (83.7%), spider naevi (41.9%) and ascites (37.2%). The most common triggers were infection (51.2%), gastrointestinal bleeding (37.2%) and constipation (25.6%). The percentage of patients with complete improvement after treatment with lactulose plus rifaximin was 81% compared to 63.6% in the lactulose-treated patients only (95% CI: 0.539 - 1.147, p value = 0.206). Conclusion: Our data revealed that common triggers of hepatic encephalopathy were infections, gastrointestinal bleeding and constipation. The combination of lactulose plus rifaximin was more effective than rifaximin alone in the treatment of overt hepatic encephalopathy. Key words: hepatic encephalopathy, precipitating factor, lactulose, rifaximin

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Comparison of efficacy of internal sphincterotomy versus topical 0.2 % glyceryl trinitrate ointment after hemorrhoidectomy.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.12.4728 ◽

2020 ◽

Vol 27 (12) ◽

pp. 2541-2547

Author(s):

Muhammad Arif ◽

Sabih Nofal ◽

Ahsan Khan ◽

Mariam Tariq Awana ◽

Anum Arif

Keyword(s):

Glyceryl Trinitrate ◽

Controlled Trial ◽

P Value ◽

Chi Square ◽

Male Predominance ◽

Internal Sphincterotomy ◽

Open Hemorrhoidectomy ◽

Group A ◽

Group B ◽

Glyceryl Trinitrate Ointment

Objectives: To compare the efficacy of 0.2% glyceryl trinitrate ointment versus internal sphincterotomy after hemorrhoidectomy. Study Design: Randomized Controlled Trial. Setting: Department of Surgery Unit III, at Lahore General Hospital, Lahore. Period: 6 months (August 2017 to February 2018). Material & Methods: The OPD of the Department of Surgery included 124 patients who satisfied the inclusion criteria. There were two groups of patients, Group A and Group B. Group-A was told to use gloved finger three times daily for 0.2 percent GTN ointment topically. For Group B, lateral internal sphincterotomy was performed as day care procedure. On visit, patients were assessed for pain relief by using VAS. All data was collected using a pre-designed (attached) proforma. In SPSS v23.0 the data were input and analyzed. It was stratified for age, sex, disease duration and hemorrhoid stage. The effectiveness of both groups was compared by using a p-value of 0.05 as significant for a chi-square test. Results: Male predominance; in group-A, 41(66.1%) patients were male and 21(33.9%) were female, while in group-B, 52(83.9%) patients were male and 10(16.1%) were females. Efficacy was found in 11(17.7%) patients in group-A (0.2% GTN) while in 25(40.3%) patients in group-B (Internal sphincterotomy) with p-value of 0.006 which is statistically significant. Conclusion: Open hemorrhoidectomy internal sphincterotomy is an effective method to reduce pain after hemorrhoidectomy in contrast to Glyceryl Trinitrate (GTN) topical cream of 0.2 percent.

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Comparison of Recovery Time of Propofol and Midazolam with Propofol Alone for Sedation in Endoscopic Retrograde Cholangiopancreatography

10.53350/pjmhs211551024 ◽

2021 ◽

Vol 15 (5) ◽

pp. 1024-1027

Author(s):

Asma Samreen ◽

Aamir Waseem ◽

Muhammad Azam ◽

Itrat Hussain Kazmi ◽

Aamir Bashir ◽

...

Keyword(s):

Endoscopic Retrograde Cholangiopancreatography ◽

Recovery Time ◽

Controlled Trial ◽

P Value ◽

Time Data ◽

Endoscopic Retrograde ◽

Intravenous Anesthetic ◽

Significant Difference ◽

Group A ◽

Group B

Background: Procedural sedation is required for multiple short duration procedures outside of the operating rooms especially in radiology and endoscopy suites. Intravenous anesthetic agent with rapid recovery profile is desirable in such circumstances. This study aims to compare two regimens of intravenous anesthetic agents. Aim: To compare the mean recovery time of propofol and midazolam with propofol alone for sedation in endoscopic retrograde cholangiopancreatography. Study Design: Randomized controlled trial. Settings: Department of Anesthesia, Shalamar Hospital, Lahore. Study Duration: June 2017 to December 2017. Methods: A total of 70 adult patients aged 20-60 years undergoing ERCP under sedation were included. Patients were given a combination of propofol and midazolam in group A while propofol alone was given in group B. After procedure, pts were transferred to recovery room and were followed for assessment of recovery time. Data were analyzed in SPSS vr 21, Independent t-test was applied & p-value ≤0.05 was considered statistically significant. Results: Significant difference was found in mean recovery time amongst both the groups. Mean recovery time in Group A (propofol and midazolam) was 19.29±4.50 minutes while in Group B (propofol alone) was 26.66±3.70 minutes showing statistically significant result with p-value = 0.0001. Conclusion: We conclude that mean recovery time with propofol plus midazolam is shorter as compared to propofol alone for sedation in ERCP. Keywords: Propofol, midazolam, sedation outside operation theatre.

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