SEVOFLURANE REQUIREMENT TO ATTENUATE STRESS RESPONSE TO PNEUMOPERITONEUM AND POST-OPERATIVE ANALGESIA DURING LAPAROSCOPIC CHOLECYSTECTOMY: INTRATHECAL DEXMEDETOMIDINE VS. FENTANYL. A PROSPECTIVE RANDOMISED STUDY

2021 ◽  
pp. 25-28
Author(s):  
J. Nirmala ◽  
Akhya Kumar Kar ◽  
Abinash Patro ◽  
A. Kireeti ◽  
Kalyani. Paighan ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Stress Response ◽  
Early Recovery ◽  
Rescue Analgesia ◽  
Post Operative Period ◽  
Haemodynamic Stress ◽  
Inhalation Agent ◽  
Group 3 ◽  
End Tidal ◽  
Group 1

Background and aims: Laparoscopic cholecystectomy is considered as the gold standard for cholelithiasis with better preservation of surgical anatomy, early recovery and post-operative analgesia but haemodynamic instability due to pneumo-peritoneum is a concern. This study was contemplated to assess the effect of intrathecal dexmedetomidine or fentanyl on end-tidal inhalation agent concentration requirement as an indirect measure of haemodynamic stress response during the creation of pneumo-peritoneum and on post-operative analgesia. Methods: This prospective, randomized, comparative study was conducted in 75 ASA I and II patients with three groups of 25 each. The patients in group-1 received 10µg of intrathecal dexmedetomidine, group-2 50µg fentanyl and group-3 equal volume of normal saline before administration of general anesthesia. We assessed the vital parameters and end-tidal concentration of sevourane requirement before and 10minutes after creation and immediately after deation of pneumo-peritoneum. Post-operative pain scores were measured using Visual analogue scale(VAS) for 24hrs and rescue analgesia was 0.5µg/kg fentanyl in the immediate post-operative period and paracetamol 15mg/kg if the score was ≥4 in the post-operative period. Results: Demographic data were comparable in all the groups. Systolic blood pressure before onset of pneumo-peritoneum(P=0.03),endtidal inhalation agent concentration to maintain stable haemodynamics post-pneumoperitoneum were signicantly low(P=0.036) in group-1 as compared to group-3. Immediate bolus dose requirement of fentanyl after extubationwas signicantly low, and the duration of post-operative analgesia was prolonged(P=0.009) in group-1.Conclusion: Intrathecal dexmedetomidine may be a safe and effective method in alleviating haemodynamic stress response during pneumo-peritoneum and provides adequate post-operative analgesia in laparoscopic cholecystectomy.

TO ASSESS THE IDEAL TIME OF LAPAROSCOPIC CHOLECYSTECTOMY AFTER ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN CASES OF CHOLELITHIASIS WITH CHOLEDOCHOLITHIASIS

2021 ◽  
Vol 5 (4) ◽  
Author(s):  
Dhirendra Godara ◽  
Vineet Choudhary ◽  
Nitish Soni
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Medical Sciences ◽  
Early Recovery ◽  
Endoscopic Retrograde ◽  
The Mean ◽  
Group 2 ◽  
Late Group ◽  
Group 1 ◽  
The Ideal

Background: Aims of this study was assess the ideal time of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography in cases of cholelithiasis with Choledocholthiasis Methods: The present study was carried out on 150 patients admitted in Department of General surgery National Institute of Medical Sciences and Research, Jaipur, diagnosed with cholelithiasis along with choledocholithiasis  from 1stJanuary 2019 to 30thJune, 2020. Results: In group 1 out of 75 patients 7 patients developed complications in post operative period compared to 35 patients out of 75 patients developed complications in group 2. The The mean hospital stay (in day) in group 1 patients was 2.26, median 2 and the mean of group 2 was 5.26, median 5. Conclusion: To conclude in our study there has been found significant advantage of early laparoscopic cholecystecomy following ERCP over the late group to minimize complications and promote early recovery of the patients. Keywords: ERCP, Cholecystectomy, Endoscopic retrograde cholangiopancreatography

scholarly journals Comparative Evaluation of Effectiveness of Intravenous Paracetamol and Intravenous Diclofenac as Post-operative Analgesia in Laparoscopic Cholecystectomy

2018 ◽  
Vol 6 (2) ◽  
pp. 6
Author(s):  
Kalpana Kharbuja ◽  
Mahesh Sharma ◽  
Nil Raj Sharma
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Visual Analogue Scale ◽  
Analogue Scale ◽  
P Value ◽  
Anesthesia Induction ◽  
Chi Square ◽  
Rescue Analgesia ◽  
Post Operative Period ◽  
Post Operative Pain ◽  
Intravenous Paracetamol

Introduction: Though the development of minimally invasive surgery  has revolutionized the field of surgery,  post-operative pain is still a significant issue. Unlike in the past, concerns about adverse effects have limited the role of opioids in post-operative pain management. This study aims to compare the effectiveness of intravenous paracetamol and  diclofenac as postoperative analgesia in laparoscopic cholecystectomy. Methods:One hundred and twenty eight patients of American Society of Anesthesiologists (ASA) categories I and II  included in this study  were divided into two groups. Anesthesia induction and maintenance were standardized. The first group received 15mg/kg (maximum 1gm) intravenous paracetamol and the second group received 2mg/kg (maximum 75mg) intravenous diclofenac 30 minutes prior to ending of surgery. A questionnaire was responded by patients and chart was maintained by visual analogue scale. Mann Whitney U test was used to analyze quantitative data and Chi-square test for categorical data. P value <0.05 was considered statistically significant. Results:  Profiles of hemodynamic changes were almost similar in both groups with respect to heart rate and blood pressure. However, paracetamol infusion provided hemodynamic stability in post-operative period. We observed statistically significant differences  in visual analogue scale between the two groups. Most of the patients in paracetamol group had low mean pain scores in post-operative period and provided an extended analgesia compared to diclofenac. No serious postoperative complication was observed in  paracetamol group.   Conclusion: Administration of intravenous paracetamol has better and prolonged analgesic effect  with low mean pain score and less requirement for rescue analgesia compared to diclofenac.

scholarly journals Experience in laparoscopic cholecystectomy in Nobel Medical College, Nepal

2019 ◽  
Vol 3 (Issue 1) ◽  
pp. 11
Author(s):  
Ruslan Sulaimankulov ◽  
Chittaranjan Das ◽  
Gulmira Jolochieva ◽  
Ashok Koirala ◽  
Rupak Bhattarai
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
College Teaching ◽  
Operation Time ◽  
Research Centre ◽  
Surgical Experience ◽  
Medical College ◽  
Conversion Rates ◽  
Group 3 ◽  
Group 1

Objective: A laparoscopic cholecystectomy (LC) is the treatment of choice for gallbladder diseases. The aim of this study is to analyze laparoscopic cholecystectomies performed by a single surgeon over 8 years at Nobel Medical College Teaching Hospital and Research Centre Pvt. Ltd. of Biratnagar, Nepal (NMCTH). Methods: We performed a retrospective analysis of 7557 patients that underwent a LC by a single surgeon, from October 2010 to July 2018. We divided it into 3 groups that include data of every three years. Results: The hospital stay, operation time and conversion rates were decreased by years of experience. Female patients outnumbered male (M:F=1:3.7) patients in this study. The hospital stay (3 days), operation time (21 min), conversion (0.3%) and complications (1.9%) rates decreased from Group 1 to Group 3 (p&lt;0.05). Conclusion: As surgical experience increased with a rising number of cases, the conversion rate, complications, hospital stay and mean operation time decreased. Key words: cholecystectomy, laparoscopy, elective, conversion, complications, mortality, gallstone, cholecystitis

scholarly journals Comparing the Effect of Dexamethasone, Normal Saline, and Metoclopramide on Prevention of Postoperative Nausea, Vomiting and Pain in Patient Undergoing Laparoscopic Cholecystectomy or Open Appendectomy: A Randomized Clinical Trial

2020 ◽  
Vol 8 (B) ◽  
pp. 139-144
Author(s):  
Mohanad Y. Al-Radeef ◽  
Sattar J. Abood ◽  
Waleed K. Abdulsahib ◽  
Salah O. Hamad
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Pain Score ◽  
Normal Saline ◽  
Open Appendectomy ◽  
Saline Group ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2 ◽  
Lower Pain Score ◽  
Group 1

BACKGROUND: Post-operative nausea and vomiting (PONV) and pain are a common complications of adult patients undergoing anesthesia, but the incidence of these complications in patients go through laparoscopic cholecystectomy or open appendectomy is unknown. AIM: We conduct this study for comparing the effect of dexamethasone administration with normal saline and with metoclopramide for reducing these undesirable effects. DESIGN: This was a three-armed, parallel-group, double-blind, and randomized controlled clinical trial. METHODS: Seventy-two patients of both genders underwent elective surgeries (laparoscopic cholecystectomy or open appendectomy), randomly assigned to three groups: A dexamethasone-treated (8 mg) group (Group 1) (n = 24), normal saline-treated (100 ml) group (Group 2) (n = 24), and metoclopramide-treated (10 mg) group (Group 3) (n = 24). All nausea, vomiting, and pain episodes were recorded during 24 h after anesthesia in three time periods: 0–4, 4–12, and 12–24 h post-anesthesia. Results: Nausea and vomiting grading scale shows no significant difference when compare dexamethasone (Group 1) with normal saline (Group 2), significant difference when compare dexamethasone (Group 1) with metoclopramide (Group 3), and also significant difference when compare normal saline (Group 2) with metoclopramide (Group 3). Group 1 showed a lower pain score (p < 0.01 and p < 0.0001) compared with pain score recorded by patients of Groups 2 and 3, respectively. Besides that, Group 2 also showed a lower pain score (p < 0.0001) compared with pain score recorded by Group 3 patients. CONCLUSION: Dexamethasone has unimportant effect when compare with normal saline, more effectiveness than metoclopramide in reducing PONV. However, dexamethasone more effective in reducing pain when comparing with normal saline and metoclopramide for patients they underwent laparoscopic cholecystectomy or open appendectomy surgery under general anesthesia.

scholarly journals Comparative evaluation of subcutaneous infiltration (port site) vs intraperitoneal infiltration of bupivacaine on post laparoscopic cholecystectomy pain

2018 ◽  
Vol 5 (2) ◽  
pp. 500 ◽  
Author(s):  
R. S. Gupta ◽  
A. Rai ◽  
Vikram Vasuniya ◽  
Devendra Choudhary
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Hospital Stay ◽  
Open Cholecystectomy ◽  
Port Site ◽  
Control Group ◽  
Narcotic Analgesics ◽  
Rescue Analgesia ◽  
Vas Score ◽  
Group 3

Background: Laparoscopic cholecystectomy (LC) is now the gold standard technique for the treatment of gallstones disease. Although pain after LC is less intense than after open cholecystectomy, some patients still experience considerable discomfort during early 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 LC.Methods: This is a randomized, prospective analytical study among patients subjected to elective laparoscopic cholecystectomy. Patients were divided into 3 groups as; Group 1 was control, Group 2 was assigned to receive portside infiltration of bupivacaine, while group 3 received combined port site and intraperitoneal instillation of bupivacaine. The evaluation of postoperative pain was done according to the visual analog scale and the dosage of narcotic analgesics consumed and duration of hospital stay was also recorded.Results: At 1st post-operative hour, minimum VAS score was in group 3 (p=0.003). At 4th post-operative hour, Minimum VAS score was in group 3(p=0.015). At 8th post-operative hour, Minimum VAS score was in group 3, (p=0.044). Patients in group 3 received a lower total amount of rescue analgesia and they also had the shortest hospital stay after LC, compared to the patients in the other groups. As regarding the incidence of right shoulder pain, group 3 has minimal no of patients experienced rt shoulder tip pain.Conclusions: Infiltration of bupivacaine into port site and intraperitoneal space is simple, inexpensive and effective technique to minimize early postoperative pain and can be practiced for elective LC.

Results of minimally invasive treatment of liver echinococcosis in comparison with traditional surgical methods

2021 ◽  
Vol 26 (4) ◽  
pp. 61-68
Author(s):  
M. S. Nagasbekov ◽  
Zh. B. Baimakhanov ◽  
Sh. A. Kaniyev ◽  
E. K. Nurlanbayev ◽  
A. T. Chormanov ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Disease Recurrence ◽  
Invasive Treatment ◽  
Early Recovery ◽  
Surgical Methods ◽  
Group 3 ◽  
Group 2 ◽  
Hepatic Echinococcosis ◽  
Group 1

Aim. To analyze the effectiveness of PAIR in comparison with traditional surgical methods.Materials and methods. A retrospective analysis of 199 patients who underwent surgical treatment of hepatic echinococcosis was carried out. Pericystectomy was performed on 95 (47.7%) patients (1st group), traditional echinococcectomy – 55 (27.6%; 2nd group), PAIR – 49 (24.6%; 3rd group). All patients received antihelmintic therapy for 2 months in the postoperative period.Results. Patients of the group 3 had significantly more CE1 cysts compared with the groups 2 and 1 – 38 (77.5%) versus 19 (34.5%) and 44 (46.3%; p < 0.05) respectively. In group 2, CE2 and CE3 cysts were predominant. The duration of the operation in group 3 was significantly shorter than in group 1 and 2 – 58.2 (25–170), 194.8 (85–440) and 217 (75–540) minutes (p < 0.05). In group 1, intraoperative blood loss was higher than in group 2 – 165.4 ml (10–1000) and 106.7 ml (10–500; p < 0.05). There were no statistically significant differences between the groups in postoperative complications according to Clavien–Dindo. The duration of postoperational hospital stay of patients from the group 3 was shorter than for 1 and 2 groups – 4.3 (2–11) days, 8.03 (5–16) days and 8.08 (4–20) days (p < 0.05) respectively. There was no disease recurrence during the follow-up period.Conclusion. The optimal treatment should be based on the stage of the disease. In CE1, the most effective method is PAIR, which is characterized by a shorter postoperational hospital stay and early recovery. In multivesicular cysts (CE2-CE3b), traditional methods of treatment are effective.

scholarly journals Efficient techniques for postoperative analgesia in laparoscopic cholecystectomy

2020 ◽  
Vol 6 (1) ◽  
pp. 1-5
Author(s):  
Chandana Madhuri T ◽  
Uma Bhanu D ◽  
Mounika P ◽  
Ganesh B ◽  
Shaik Mujafar ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Analgesia ◽  
Transversus Abdominis ◽  
Rescue Analgesia ◽  
Pain Scores ◽  
Affected Person ◽  
Selection For ◽  
Group 2 ◽  
Technological Improvements ◽  
Group 1

Today, in a generation of technological improvements, Laparoscopic cholecystectomy (L.C.) is the selection for the treatment of symptomatic illnesses of gallbladder like cholecystitis and cholelithiasis. Legitimate pain control is essential for advancing scientific outcomes and previous ambulation after surgery. Results aren't suitable for daycare surgeries. It is minimally invasive with much less postoperative ache, rapid recuperation, lesser health facility live and return to everyday interest on the earliest1. Though laparoscopic cholecystectomy is a slightly invasive surgical procedure with more secondary perioperative pain scores assessment to open procedures, it is present with enormous ranges of postoperative ache. The present prospective, unmarried blinded, randomized manipulate study protected sixty patients scheduled for laparoscopic cholecystectomy and aimed to compare the postoperative analgesia between the posterior transversus abdominis plane block and subcostal transversus abdominis aircraft block. The patients were randomly allotted to 2 businesses- Group 1 consisted of patients who received posterior T.A.P. block with zero. 2% Ropivacaine with Dexmedetomidine 1mcg/kg and Group 2 consisted of patients who obtained subcostal T.A.P. block with zero.2% Ropivacaine with Dexmedetomidine 1mcg/kg. All patients underwent laparoscopic cholecystectomy under general anaesthesia. At the quit of the surgical operation earlier than extubation, both one of the blocks were executed on the affected person underneath ultrasound steering by the identical anaesthesiologist. The objectives of the study were to compare the postoperative pain relief based on VAS at rest and VAS at deep breathing, to compare the time taken for the administration of rescue analgesia (duration of analgesia) and to compare the time taken to perform the block.

scholarly journals Evaluation of the Effects of Ultrasound-Guided Transversus Abdominis Plane Block on Perioperative Analgesia and Patient Comfort in Patients Undergoing Laparoscopic Cholecystectomy

2021 ◽  
Author(s):  
Kevser Dilek Andıç ◽  
Aysu Hayriye Nadir ◽  
Ayşe Lafçı ◽  
Nermin Göğüs
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Transversus Abdominis Plane Block ◽  
Transversus Abdominis ◽  
Patient Comfort ◽  
Patient Controlled Analgesia ◽  
Transversus Abdominis Plane ◽  
Perioperative Analgesia ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Objective: Inadequate pain management after laparoscopic cholecystectomy is an important problem that can lead to complications and negatively affect the patient’s recovery. Transversus abdominis plane block can contribute to postoperative analgesia in abdominal surgeries. The aim of this study is to investigate the effects of preoperative unilateral or bilateral transversus abdominis plane block on perioperative analgesia in patients underwent laparoscopic cholecystectomy and its contribution to patient comfort. Methods: A total of 75 patients were randomized into 3 groups as Group-1 (n=25) without unblocking, Group-2 (n=25) with unilateral block and Group-3 (n=25) with bilateral block. Block was applied to Group 2 and Group 3 under general anesthesia before surgery. Demographic characteristics of patients, intraoperative opioid consumption, postoperative 30 min, 2, 4, 8, 12 and 24 hours VAS rest-VAS cough scores, analgesic consumption in patient controlled analgesia, postoperative additional analgesic requirement, side effects, mobilization times and patient satisfaction were recorded. Results: The dose of remifentanil consumed intraoperatively was significantly lower in Group-3. VAS values were significantly different among the groups until the 12th hour postoperatively. The VAS rest and VAS cough values were lower in the Group 3. There was a significant difference among the groups in the patient-controlled analgesia devices when the bolus dose demand/given amounts and the total amount of drugs requested/consumed were compared. Total drug consumption was determined in the highest Group-1 and the lowest in Group-3. The satisfaction scores of the patients in group-3 were higher than the other groups. Conclusion: Our study showed that transversus abdominis plane block application in laparoscopic cholecystectomy surgeries contributed to decreased perioperative analgesic consumption and lower VAS scores up to 12 hours. Transversus abdominis plane block, which was performed with laparoscopic cholecystectomy in the preoperative period, has been shown to be an effective analgesic method.

Sign in / Sign up

Export Citation Format

Share Document