KETAMINE INFUSION FOR MANAGEMENT OF EARLY POSTOPERATIVE PAIN FOLLOWING ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY: ASSESSMENT OF OPTIMUM DOSE

2021 ◽  
pp. 27-30
Author(s):  
Hembrom Bani Parvati Magda ◽  
John Christian S ◽  
Laha Baisakhi ◽  
Ray Manjushree
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Cognitive Function ◽  
Postoperative Pain ◽  
Continuous Infusion ◽  
Postoperative Period ◽  
Diclofenac Sodium ◽  
Optimum Dose ◽  
Ketamine Infusion ◽  
Ketamine Hydrochloride ◽  
Elective Laparoscopic Cholecystectomy

Background: This study is aimed to assess an optimal dose of ketamine infusion for management of early postoperative pain in elective laparoscopic cholecystectomy. Intensity of pain, requirement of rescue analgesics and tness to discharge were assessed during immediate postoperative period. Methodology: Randomised controlled prospective clinical trial was conducted in 140 patients of laparoscopic cholecystectomy and, allocated in four groups of 35 each. Standard anaesthetic regimen was used in all patients, using propofol for induction, atracurium for muscle relaxation and isourane for maintenance of anaesthesia. Continuous infusion of the test drug was administered by intravenous cannula placed in alternate hand -1 -1 from start of port placement till wound closure. Group K1, K2 and K3 received an infusion of ketamine hydrochloride at a rate of 20 µg kg min , 30 -1 -1 -1 -1 µg kg min and, 40 µg kg min respectively, while Group N received normal saline. Postoperative pain score, requirement of rescue analgesia, degrees of sedation and postoperative cognitive function were examined postoperatively. Results: -1 Visual analog scale score ≥ 4 was considered signicant pain and, rescue analgesic injection diclofenac sodium 75mg kg was administered. Duration of analgesia was 130.71 ± 82.41, 457.14 ± 150.373, 520.97 ± 189.338 and, 524.83 ± 141.436 minutes in group N, K1, K2 and K3 respectively. Out of 35 patients 28, 4, 0 and, 0 patients required three doses of diclofenac sodium in 24 hours in N, K1, K2 and K3 group respectively. Conclusions: -1 -1 Continuous infusion of ketamine hydrochloride at a rate of 30 µg kg min during intraoperative period provide effective pain relief during early postoperative period without inuencing cognitive function of the patients.

Prospective, Double-Blinded, Randomized, Placebo-Controlled Comparison of Local Anesthetic and Nonsteroidal Anti-Inflammatory Drugs for Postoperative Pain Management after Laparoscopic Surgery

2007 ◽  
Vol 73 (6) ◽  
pp. 618-624 ◽  
Author(s):  
William Newcomb ◽  
Amy Lincourt ◽  
William Hope ◽  
Thomas Schmelzer ◽  
Ronald Sing ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Length Of Stay ◽  
Oral Administration ◽  
Local Anesthetic ◽  
Local Infiltration ◽  
Elective Laparoscopic Cholecystectomy ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Double Blinded

Compared with the open approach, laparoscopy has been shown to significantly reduce postoperative pain. Improving postoperative analgesia in laparoscopic surgery is an area of continued interest. The goal of this study was to compare the efficacy of local anesthetic infiltration with or without preoperative nonsteroidal anti-inflammatory drugs. Patients undergoing elective laparoscopic cholecystectomy were enrolled in an Institutional Review Board-approved, prospective, double-blinded, randomized, placebo-controlled comparison study. Patients were randomized into four groups: Group I, preoperative oral administration of a placebo medication and prein cision local infiltration of 40 mL of 0.5 per cent bupivicaine at trocar sites; Group II, preoperative oral administration of 50 mg of rofecoxib; Group III, preoperative oral administration of 50 mg of rofecoxib and preincision local infiltration of 40 mL of 0.5 per cent bupivicaine into skin, muscle, and peritoneum; and Group IV, preoperative oral administration of a placebo medication. Postoperative pain scores were assessed at 4 hours, 8 hours, 12 hours, and 24 hours using a visual analog scale. Postoperative analgesic use, complications, and length of stay were recorded. Statistical significance was defined as P < 0.05. Fifty-five patients (46 women and 9 men) were enrolled in this study and underwent a standardized, elective, laparoscopic cholecystectomy for mild, symptomatic cholelithiasis (96.4%) and gallbladder polyps (3.6%). No patient had pain immediately before surgery. Postoperative analgesic requests, visual analog scale results, incidence of postoperative vomiting at 4 hours, 8 hours, 12 hours, and 24 hours, in addition to length of stay, were not statistically different between the four groups. No complications occurred. The use of preoperative rofecoxib, 0.5 per cent bupivicaine infiltration, or both for postoperative analgesia did not decrease postoperative pain or decrease length of stay after laparoscopic cholecystectomy compared with placebo. Preoperative administration of an oral anti-inflammatory pain medication, infiltration of a local anesthetic, or both had no greater effect than placebo in controlling discomfort after a laparoscopic cholecystectomy. The challenge of preempting postoperative pain continues and will require further investigation.

scholarly journals Is Opioid-Free General Anesthesia More Superior for Postoperative Pain Versus Opioid General Anesthesia in Laparoscopic Cholecystectomy?

PRILOZI ◽  
2019 ◽  
Vol 40 (2) ◽  
pp. 81-87
Author(s):  
Marija Toleska ◽  
Aleksandar Dimitrovski
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
General Anesthesia ◽  
Postoperative Period ◽  
Safe Procedure ◽  
Pain Scores ◽  
Post Operative Period ◽  
Significant Difference ◽  
Balanced Anesthesia ◽  
Elective Laparoscopic Cholecystectomy ◽  
Fentanyl Group

Abstract Introduction: Opioid-free anesthesia (OFA) is a new anesthesiological technique, where the giving of opioids (fentanyl) is avoided in the intra- and post-operative period. This leads to reduction in the opioid-related side effects and lower pain scores in the postoperative period. Materials and methods: In this randomized, single-blind clinical study, 60 patients scheduled for elective laparoscopic cholecystectomy were enrolled. Half of them (30 patients) received general balanced anesthesia with fentanyl (F group-FG), and the half received opioid-free general anesthesia (OFA group-OFAG). In the post-operative period, Visual Analogue Scale (VAS) scores were followed at rest and when coughing 1 hour, 4 hrs, 8 hrs, 12 and 24 hrs after surgery. Both groups were followed by opioid requirements in the postoperative period. Results: In the postoperative period, patients in the fentanyl group (FG) have higher pain scores at rest and on coughing in all analyzed timeframes compared to patients from the OFA group, but statistically significant difference was approved 1 and 24 hours after surgery. In the OFA group 24 hours after surgery none of the patients reported pain at rest and when coughing number 7, 8, 9 and 10 according to the VAS pain score. The total opioid requirement in the postoperative period was significantly higher in the fentanyl group (FG) at rest and when coughing, compared to the OFA group. Conclusion: Opioid-free anesthesia as a part of multimodal analgesia and a new anesthesiology technique is a safe procedure, where opioid-related negative effects in patients undergoing elective laparoscopic cholecystectomy are avoided..

scholarly journals Port Site Infiltration and Intraperitoneal Instillation of Bupivacaine for Post Operative Analgesia in Laparoscopic Cholecystectomy

2020 ◽  
Vol 14 (2) ◽  
pp. 58-61 ◽  
Author(s):  
Lipika Sanjowal ◽  
Swapan Kumar Biswas
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Study Groups ◽  
Treatment Method ◽  
Port Site ◽  
Control Group ◽  
Vas Score ◽  
Intraperitoneal Instillation ◽  
Elective Laparoscopic Cholecystectomy ◽  
Experimental Group

Laparoscopic cholecystectomy has become the gold standard treatment method for symptomatic gallstone diseases. However pain is the only complaint that delays the discharge. This study aimed to evaluate the efficacy of bupivacaine infiltration into port site and instillation into peritoneal cavity to reduce pain following laparoscopic cholecystectomy. One hundred patients underwent elective laparoscopic cholecystectomy enrolled in this study. Patients were divided into experimental group (Group A) and control group (Group B) of 50 patients each. Following removal of gallbladder, patients of experimental group received 20 ml of 0.5% bupivacaine in gallbladder bed and 20 ml of 0.5% bupivacaine was infiltrated into 4 port sites. Control group received no treatment. The evaluation of postoperative pain was done at 4, 8, 12 and 24 hours postoperatively by using Visual Analogue Scale and the dose of NSAID was also recorded. Mean VAS score at 4, 8 and 12 hours postoperatively in experimental group was less than that of the control group (p<0.05). VAS score at 24 hours postoperatively did not differ between two study groups (p>0.05). The mean total NSAID doses used during first 24 hours postoperatively was less in the experimental group than control group (p<0.05). The localization of pain during first 24 hours postoperatively was 62% incisional, 29% intra abdominal and shoulder tip pain 9%. Port site infiltration and intraperitoneal instillation of bupivacaine following laparoscopic cholecystectomy reduce pain following laparoscopic cholecystectomy and this simple, inexpensive and effective method should be practiced to minimize early postoperative pain for all elective laparoscopic cholecystectomy. Faridpur Med. Coll. J. Jul 2019;14(2): 58-61

scholarly journals Port Site and Intraperitoneal Infiltration of Local Anesthetics in Reduction of Postoperative Pain after Laparoscopic Cholecystectomy

1970 ◽  
Vol 22 (1) ◽  
pp. 24-28 ◽  
Author(s):  
Mohammad Shaha Alam ◽  
Hasnat Waheedul Hoque ◽  
Mohammad Saifullah ◽  
Md Omar Ali
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Open Cholecystectomy ◽  
Early Postoperative Period ◽  
Port Site ◽  
Control Group ◽  
Time Interval ◽  
Narcotic Analgesics ◽  
Pain Scores ◽  
Elective Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy is now the gold standard technique for the treatment of gallstones disease. Although pain after laparoscopic cholecystectomy is less intense than after open cholecystectomy, some patients still experience considerable discomfort during the first 24 to 72 postoperative hours. The aim of this study is to evaluate the effect of intraperitoneal and port site instillation of local anaesthetics on pain relief in early postoperative period following laparoscopic cholecystectomy. Fifty patients undergoing elective laparoscopic cholecystectomy were consecutively included in this study and sample was divided into two groups. Following removal of gallbladder, Group A received 20 ml of 0.25% bupivacaine instilled in the right sub diaphragmatic space and 20 ml of 0.25% bupivacaine in divided doses at the trocar sites. The evaluation of postoperative pain was done at fixed time interval according to the numerical verbal scale and the dosage of narcotic analgesics consumed was also recorded. Mean pain scores at 6 hours and at 12 hours after surgery were 6.02 and 4.72 respectively, in the bupivacaine group compared with 8.44 and 6.08 respectively in the control group (p= <0.001 and <0.001). However, pain scores at 24 hours and 48 hours postoperatively and incidence of shoulder tip pain did not differ significantly between the two groups. The mean total narcotic analgesics used in study group was 1.91 as compared to 2.50 in the control group respectively and was found to be statistically significant (p= <0.001). Infiltration of bupivacaine in to port site and intraperitoneal space is simple, inexpensive and effective technique to minimize early postoperative pain and can be practiced for elective laparoscopic cholecystectomy.   DOI: 10.3329/medtoday.v22i1.5601 Medicine Today Vol.22(1) 2010. 24-28

Preoperative Multimodal Analgesia for Laparoscopic Cholecystectomy

2018 ◽  
pp. 217-222
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Study Groups ◽  
Multimodal Analgesia ◽  
Double Blind Study ◽  
Double Blind ◽  
Same Day Discharge ◽  
Elective Laparoscopic Cholecystectomy ◽  
American Society ◽  
American Society Of Anesthesiologists

This case focuses on the use of local anesthesia, nonsteroidal anti-inflammatory or opioid drugs, for laparoscopic cholecystectomy by asking the question: Does prophylactic multimodal nociceptive blockade delay the onset of postoperative pain, decrease analgesic requirements, speed recovery, and facilitate same-day discharge in patients undergoing elective laparoscopic cholecystectomy? In this randomized, double-blind study, intraoperative anesthetic care and postoperative pain and nausea management were standardized for all patients. Study groups were similar in terms of patient age, gender, weight, American Society of Anesthesiologists class, baseline and preinduction pain and nausea scores, duration of surgery, and total dose of propofol received. This study demonstrated the benefit of preoperative multimodal analgesia on recovery and discharge.

scholarly journals Efficacy of Continuous S(+)-Ketamine Infusion for Postoperative Pain Control: A Randomized Placebo-Controlled Trial

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Luiz Eduardo de Paula Gomes Miziara ◽  
Ricardo Francisco Simoni ◽  
Luís Otávio Esteves ◽  
Luis Henrique Cangiani ◽  
Gil Fernando Ribeiro Grillo-Filho ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Pain Control ◽  
Controlled Trial ◽  
Intervention Group ◽  
Morphine Consumption ◽  
Postoperative Pain Control ◽  
Intravenous Anesthesia ◽  
Ketamine Infusion ◽  
Pain Scores

Aim.A double-blind, randomized, placebo-controlled trial was designed to evaluate the efficacy of continuous intraoperative infusion of S(+)-ketamine under intravenous anesthesia with target-controlled infusion of remifentanil and propofol for postoperative pain control.Methods.Forty-eight patients undergoing laparoscopic cholecystectomy were assigned to receive continuous S(+)-ketamine infusion at a rate of 0.3 mg·kg−1·h−1(n=24, intervention group) or an equivalent volume of saline at the same rate (n=24, placebo group). The same target-controlled intravenous anesthesia was induced in both groups. Pain was assessed using a 0 to 10 verbal numeric rating scale during the first 12 postoperative hours. Pain scores and morphine consumption were recorded in the postanesthesia care unit (PACU) and at 4 and 12 hours after surgery.Results.Pain scores were lower in the intervention group at all time points. Morphine consumption did not differ significantly between groups during PACU stay, but it was significantly lower in the intervention group at each time point after PACU discharge (P=0.0061). At 12 hours after surgery, cumulative morphine consumption was also lower in the intervention group (5.200±2.707) than in the placebo group (7.525±1.872).Conclusions.Continuous S(+)-ketamine infusion during laparoscopic cholecystectomy under target-controlled intravenous anesthesia provided better postoperative pain control than placebo, reducing morphine requirement.Trial Registration. This trial is registered with ClinicalTrials.govNCT02421913.

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