Comparison of post-operative pain after laparoscopic total extraperitoneal mesh repair of indirect inguinal hernia with tacker

2021 ◽  
Vol 15 (10) ◽  
pp. 2733-2735
Author(s):  
Shahid Hussain ◽  
Asiya Shabbir ◽  
Muhammad Asif
Keyword(s):  
Inguinal Hernia ◽  
Mesh Repair ◽  
Indirect Inguinal Hernia ◽  
Satisfactory Outcome ◽  
Post Operative Pain ◽  
Total Extraperitoneal ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Laparoscopic Tep

Objectives: To compare the post-operative pain after laparoscopic total extraperitoneal mesh repair of indirect inguinal hernia with tacker and without tacker fixation. Materials & Methods: This comparative study was done at Surgical Department of Bahawal Victoria Hospital, Bahawalpur from May 2020 to November 2020 over the period of 6 months. Total 182 patients with indirect inguinal hernia, having age range from 20 to 60 either male or female were selected. In group A patients, laparoscopic TEP mesh repair of inguinal hernia without tacker fixation was done while in group B patients, laparoscopic TEP mesh repair of inguinal hernia with tacker fixation was done. Patients were assessed for post-operative pain and outcome (satisfactory/unsatisfactory) at 1 month follow up. Results: Average of patients was 41.33 ± 12.37 years and 40.83 ± 12.04 years in group A and group B. Out of 182 patients, 170 (93.41%) were males and 12 (6.59%) were females. Mean post-operative pain in Group A was 1.46 ± 1.50 while in Group B was 1.77 ± 2.08 (p-value=0.2505). Satisfactory outcome was noted in 84 (92.31%) patients and 67 (73.63%) patients of group A and B and the difference was significant (P = 0.001). Conclusion: Results of this study showed that there is a significant difference of satisfactory outcome (less post-operative pain) between the non-fixation and fixation group. Difference of satisfactory outcome was also significant between male patients, diabetics and obese patients of both groups. Keywords: Inguinal hernia, laparoscopic, mesh, tacker fixation

The Outcome Comparison of two Groups of total Extraperitoneal and Mesh Repair of Inguinal Hernia

2021 ◽  
Vol 15 (10) ◽  
pp. 2712-2714
Author(s):  
Muhammad Aamir Jamil ◽  
Muhammad Asif ◽  
Imran Yousaf ◽  
Muhammad Faheem Anwer ◽  
Muhammad Waseem Anwar
Keyword(s):  
Inguinal Hernia ◽  
Hospital Stay ◽  
Recovery Time ◽  
Mesh Repair ◽  
Operative Procedure ◽  
Total Extraperitoneal ◽  
Outcome Comparison ◽  
Group A ◽  
The Mean ◽  
Group B

Aim: The outcome comparison of total extraperitoneal versus mesh repair for inguinal hernia. Study design: Quasi experimental study. Place and duration of study: Department of Surgery, M. Islam Teaching Hospital, Gujranwala from March 2018 to March 2019. Methodology: After the approval of hospital ethical committee, a total of 50 patients were included and randomly divided into two groups equally. Group A (Total extraperitoneal), Group B (Mesh repair). An informed consent was taken from every patient about operative procedure and the outcome. A detailed history of the patient i.e. clinical examination, routine investigations (CBC, Urine R/E, urea, creatinine) and some specific investigations (chest X-ray, ECG and ultrasound abdomen and prostate) was done for surgery. All data of patients was collected on proforma and was analyzed with the help of a computer SPSS programme 20. Results: The mean age of patients was 34.22±11.54 years in group A and 35.63±11.25 years in group B. All male and female patients included in this study in both groups. Twelve (48%) of patients were direct inguinal hernia in group A 13(22%) were in group B and 14(56%) patients were in group A and 11(44%) patients were in group B. The mean±SD postoperative hospital stay was 24.48±4.62 in group A and 34.65±12.26 hours in group B (p 0.001). The mean±SD postoperative recovery time in weeks was 2.18±0.43 in group A and 2.90±0.46 weeks in group B (p 0.001). Only 2 (4%) patient had postoperative infection on first week and 4 (8%) patients had infection respectively. No recurrence was seen in group A and only 3% recurrence was in group B. Conclusion: It is concluded that group A had shorter hospital stay, recovery time, postoperative time and less infection rate as compared to group B. In group A 13% patients had severe pain and in group B 25% patients. Keywords: Inguinal Hernia, Total extraperitoneal, Mesh repair.

scholarly journals A randomised controlled trial of excision versus invagination in the management of indirect inguinal hernial sac

2019 ◽  
Vol 101 (2) ◽  
pp. 119-122
Author(s):  
M Sharma ◽  
OP Pathania ◽  
A Kapur ◽  
S Thomas ◽  
A Kumar
Keyword(s):  
Inguinal Hernia ◽  
Postoperative Pain ◽  
Testicular Atrophy ◽  
High Ligation ◽  
Indirect Inguinal Hernia ◽  
Tension Free ◽  
Hernial Sac ◽  
Significant Difference ◽  
Group A ◽  
Group B

Introduction Lichtenstein tension-free mesh hernioplasty of primary inguinal hernia is currently considered as the preferred method for the plastic reconstruction of inguinal hernia by the majority of surgeons. Several studies have examined the best way to manage the hernial sac in this surgery, but no consensus has been reached. This study was designed to compare the effects of excision of sac and invagination of sac on post-operative outcomes. Methods and methods This prospective randomised study included a total of 70 patients with primary unilateral uncomplicated indirect inguinal hernia. Group A (35 patients) underwent high dissection and invagination of the hernial sac and group B (35 patients) underwent high ligation and excision of the hernial sac. The repair of the posterior wall of the inguinal canal was done according to Lichtenstein tension-free technique. The primary outcome of this study was postoperative pain and secondary outcomes were wound infection, chronic sepsis, sinus formation, persistent pain, testicular atrophy and recurrence during the one-year follow-up period. Results There was a significant difference (P < 0.01) in pain experienced by the patients in the immediate post-operative period between the two groups; group A experienced less postoperative pain than group B. There was no significant difference in incidence of infection between the groups. Conclusions Invagination of the sac results in less postoperative pain compared with excision, with no significant difference in other postoperative outcomes.

scholarly journals A Study of Outcomes of Conventional Open Hernia Repair with Self-Fixation Mesh versus Total Extra Peritoneal (Tep) Suture-Free Mesh Repair

2018 ◽  
Vol 3 (3) ◽  
Keyword(s):  
Hernia Repair ◽  
Mesh Repair ◽  
Hernia Recurrence ◽  
Study Objective ◽  
Post Operative Pain ◽  
Number Of Patients ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Open Hernia Repair

Study objective: To compare the outcomes of self-fixation mesh for open hernia repair with TEP suture free mesh repair in terms of patients with post-operative pain one month after surgery and recurrence rate of hernia. Methods & Material: The study was conducted at Sharif Medical & Dental College, Lahore, Pakistan. 100 cases of inguinal hernia were operated. In 50 patients (Group A) open hernia repair was done. In another 50 cases (Group B) TEP mesh repair was done. Data was analyzed using IBM SPSS 24. Post-operative surgical outcomes in terms of patients with pain one month after surgery and hernia recurrence were studied in two groups. Descriptive statistics (frequencies and percentages) were calculated. Chi-square test of statistical significance for quantitative variables was applied. Results: In group B only 1/50 patient suffered from post-operative pain one month after surgery as compared to 21 in Group A. Similarly incidence of hernia recurrence was 1/50 in Group B as compared to 8/50 in Group A. Both for post-operative pain and hernia recurrence there was a statistically significant difference between the two groups. In Group A number of patients with post-operative pain one month after surgery and those with hernia recurrence was significantly high than in Group B (p< 0.001, p< 0.05). Conclusion: In terms of post-operative pain one month after surgery and incidence of hernia recurrence TEP suture free repair is a superior method of hernia repair as compared to conventional open repair

Role of a modified epigastric port in reducing post operative pain and causing early ambulation in a patient undergoing laparoscopic cholecystectomy as compared to a standard four port procedure, a randomized controlled study

2020 ◽  
Vol 7 (12) ◽  
pp. 3986
Author(s):  
Arijit Roy ◽  
Pramatha Nath Datta ◽  
Kushankur Guha
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Recovery ◽  
Controlled Study ◽  
Post Operative Pain ◽  
Quality Life ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
To Receive ◽  
Better Than

Background: Standard four port laparoscopic cholecystectomy is the gold standard in the treatment of gall stones. Modified epigastric port laparoscopic cholecystectomy may be considered an alternative, as this procedure maintains the advantages of four ports and does not require any special set of instruments. In this study we aimed to see whether this procedure is comparable to the standard four port laparoscopic cholecystectomy based on the primary objectives of postoperative pain score, degree of ambulation, time to return to normal activities.Methods: Consecutive patients due to undergo laparoscopic cholecystectomy, meeting all the predefined criteria were recruited into the study. The group A was assigned to receive intervention in the form of modified epigastric port laparoscopic cholecystectomy. The group B was assigned to receive intervention in the form of standard four port laparoscopic cholecystectomy. Patients in group A were compared with patients in group B based on multiple pre-defined parameters.Results: Pain scores were significantly better in group A. Degree of ambulation at was significantly better in group A. In respect to the time to resumption of normal activities there was no significant difference between the two groups. When comparing the quality life at 1 month following surgery with SF-36 health survey, the patients in group A did better than patients in group B with respect to the six scales. Conclusions: Modified epigastric port laparoscopic cholecystectomy appears to be significantly better than the standard four port cholecystectomy in terms of postoperative recovery.

scholarly journals Laparoscopic total extraperioneal mesh hernioplasty is a novel approach for inguinal hernia: our experience over 7 years

2019 ◽  
Vol 6 (11) ◽  
pp. 3982
Author(s):  
Dheer Singh Kalwaniya ◽  
Ranjith Mahadevan ◽  
Satya V. Arya ◽  
Jaspreet Singh Bajwa ◽  
Gowtham K. Gowda ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Mesh Repair ◽  
Wound Complications ◽  
Indirect Inguinal Hernia ◽  
Bilateral Inguinal Hernia ◽  
Hernia Surgery ◽  
Early Recovery ◽  
Inguinal Hernia Surgery ◽  
Laparoscopic Tep

Background: Inguinal hernia surgery is the most common performed surgery all over the world. Among them laparoscopic totally extra-peritoneal (TEP) mesh repair fulfils all the requirements with better clinical outcomes than other procedures.Methods: Data was collected from the inpatient and out-patient records of 60 patients who underwent laparoscopic TEP for unilateral or bilateral inguinal hernia in a single unit in the Department of General Surgery during May 2012-June 2019 including the two years of follow-up. 3D mesh was used for application and was fixed with tackers. Then patients were followed up in outpatient department after 1 week, 2 week, and 3 months, 6 months and yearly up to two years. In every visit post-operative pain (assessed by visual analogue scale), local wound complication (hematoma, seroma, wound infection) and recurrence were noted. The data was collected and evaluated and the results shown.Results: All patients were men, with average age of 36.5 years (range 32-58). On categorization 53 (88.3%) of them had unilateral inguinal hernia and 7 (11.6%) of them had bilateral inguinal hernia. Intra operatively 12 (20%) of them had direct inguinal hernia and 48 (80%) of them had indirect inguinal hernia. Haematoma was seen in 1 patients, surgical emphysema in 3, seroma in 5 and recurrence in 2 patients.Conclusions: Laparoscopic TEP mesh repair was effective and safe tool for hernia repair, in terms of lesser postoperative painless number of hospital days, early recovery and lesser wound complications. However recurrence rates are comparable with other methods of hernia repair.

scholarly journals Desarda’s versus Lichtenstein technique of inguinal hernia repair

2017 ◽  
Vol 5 (1) ◽  
pp. 92
Author(s):  
Obaid Syed
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Hospital Stay ◽  
Complication Rate ◽  
Mesh Repair ◽  
Post Operative Pain ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Operative Complications ◽  
The Mean

Background: Ideal method for modern hernia surgery should be simple, cost effective, safe, tension free and permanent. The Lichtenstein operation to a great extent achieves this entire goal. The Lichtenstein mesh repair is associated with complications, postoperative dysfunction and high cost composite meshes. Desarda's technique, became a new surgical option for tissue-based inguinal hernia repair. The present study was designed to evaluate and compare the effectiveness and complications of the Desarda’s repair with Lichtenstein tension-free mesh repair for treatment of inguinal hernia in a developing country.Methods: 200 patients with unilateral, primary, reducible inguinal hernia were selected. Included patients were randomly divided into two groups. Studied parameters were Duration of surgery, intra operative complications, post-operative Pain, Duration of hospital stay, return to normal activities, post-operative complications and recurrences.Results: There were a total of 100 patients each group. There was no statistically significant difference in duration of surgery and complication rate between the two groups. Difference in mean VAS was not statistically significant. The mean hospital stay in Desarda’s technique was 2.5 days while it was 2.6 days in Lichtenstein’s group. The mean time to return to basic physical activity in the Desarda’s technique was 12.6 days while it was 13.3 days in the Lichtenstein’s group. There were no recurrences in either group. Chronic inguinal pain (>1month) was more frequent in Lichtenstein’s group.Conclusions: There is no significant difference in duration of surgery, intra operative complication rate, post-operative pain, complications and recurrence, between Desarda’s technique and Lichtenstein’s technique. However chronic inguinal pain is less in Desarda’s technique. Desarda’s repair must be considered in young patients (<30 years). Its long-term efficacy needs to be studied with larger, prospective double-blind randomized trials, with longer follow-up.

scholarly journals INGUINAL HERNIA REPAIR;

2014 ◽  
Vol 21 (06) ◽  
pp. 1144-1146
Author(s):  
Iftikhar Ahmed Bhatti
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Prosthetic Mesh ◽  
Indirect Inguinal Hernia ◽  
Female Ratio ◽  
Male Female Ratio ◽  
Group A ◽  
Group B

Objective: To compare the results of Inguinal Hernia repair using commonly employed methods of Bassini’s and Mesh repair. Methodology: This study included 90 cases of hernia repair ranging over a period of 18 months from October 2008 to Mar 2010 at Social Security Hospital Lahore. All the cases were done by the consultants and senior surgeons. The methods of repair included Bassini’s and Hernioplasty with Prosthetic mesh. Results: Out of 90 patients, 88 were males (97.78%) and 02 were females (2.22%). Male – female ratio 45 : 1. The peak incidence was found in 3rd and 4th decades of life. 56(62.22%) had Rt.sided Inguinal hernia, 29 (32.22%) had Lt. sided and 5(5.56%) had bilateral Inguinal hernia. 72 patients (80%) had Indirect Inguinal hernia, 17 (18.89%) had direct inguinal hernia while 1(1.11%) had both types. All the cases were done under Spinal anaesthesia. The Bassini’s repair was performed in 50% cases, using non-absorble no. 1 Prolene interrupted suturing (Group- A). In the Group – B, 50% cases underwent Hernioplasty with prosthetic prolene mesh 6x11 cms. Post-operative follow up was done for a period of 01 year. In the group- A, 3 (6.67%) patients had recurrence and 3 (6.67%) had infection of the wound. In group – B, 01 patient (2.22%) got infected and none of the cases did not get recurrence over a period of 01 year. Conclusions: Hernioplasty with prosthetic mesh is a better treatment modality for inguinal hernia repair to get a low recurrence rate.

scholarly journals Ilioinguinal Neurectomy and Chronic Post-Operative Pain After Inguinal Hernia Repair

2020 ◽  
pp. 1-7
Author(s):  
Aliya Ishaq ◽  
Muhammad Shadab Khan ◽  
Mariya Ishaq ◽  
Ayesha Saba ◽  
Turab Pishori
Keyword(s):  
Inguinal Hernia ◽  
P Value ◽  
Third Wave ◽  
Brisk Walking ◽  
Healthcare Facilities ◽  
Nerve Preservation ◽  
Post Operative Pain ◽  
Group A ◽  
Group B

Objective: This study aims to determine the effect of preservation /division of ilioinguinal nerve in patients undergoing lichenstein hernioraphy on severity of chronic post operative pain as well well as presence /absence of groin numbness. Method: A randamised control trial was conducted for a period of six months on 60 patient fulfilling inclusion criteria who underwent lichenstein hernioraphy at general surgery department of Liaquat National university hospital Karachi , Pakistan. Result: A total of 60 patients undergoing elective inguinal hernia mesh repair were Included in study and divided in two groups with 30 patients each. Only male patients were included in the study as female gender was one of the exclusion criteria so gender stratification was no considered. Patients between 17 to 77 yrs of age were included in study and randomly divided in two groups. Mean age of population in group A is 42.96 +/- 17.76 an in group B is 54.23 +/- 15.0. The minimum age of the patient in Group A is 17 years and maximum age is 73 years whereas minimum age of the patient in Group B is 20 years and maximum age is 77 years. 45.9% Patients in group A (Nerve preservation group) have right inguinal hernia. 54.0%% Patients in group B (Nerve Division group) have right inguinal hernia. 56.5%% Patients in group A (Nerve Preservation group) have left inguinal hernia. 43.4% Patients in group B (Nerve Division group) have left inguinal hernia. Chronic groin pain while different physical activities and groin numbness in nerve preservation and nerve division group was assessed at three and six months follow ups in all patients of the study population. 3% of the patients from nerve preservation group had mild pain during climbing stairs at three and six months follow up and the P-Value was 0.313 which is statistically not significant. 10% of the patients from nerve division group and 50% patients from nerve preservation group had pain during brisk walking at three months follow up and the P-Value was 0.001 which is statistically significant. 23% of the patients from nerve division group and 60% patients from nerve preservation group had pain during brisk walking at six months follow up and the P-Value was 0.004 which is statistically significant. 13.3% patients from nerve preservation group had moderate pain during brisk walking at three months follow up while none of the patient from nerve division group had pain and P-Value was 0.038 which is statistically significant. 6.6% of the patients from nerve preservation group had moderate pain during brisk walking at six months follow up while none of the patient from nerve division group had pain and p-value was 0.150 which is statistically in significant. 20% of the patients from nerve division group and 30% of the patients from nerve preservation group had mild groin numbness at three months follow up with P-Value of 0.371 which is statistically in significant. 33.3% of the patients from nerve division group and 30% of the patients from nerve preservation group had groin numbness at six months follow up with a p-value of 0.781 which is statistically in significant. Conclusion: Prophylactic ilioinguinal neurectomy during Lichtenstein tension free inguinal hernia repair decreases the incidence of exertional chronic post operative pain as compare to the nerve preservation group. However the cutaneous neurosensory disturbance/groin numbness between the two groups has no difference in term of outcome. In order to prepare ourselves from a expected third wave of Covid-19, we should not repeat mistakes that we made during previos waves. We should refrain ourselves from dismantling our enhanced healthcare facilities, there should not be any sorts of shortage of oxygen , hospital beds, and drug that we have already witnessed. We must have an aggressive containment measure comprising of a really strong and pro-active surveillance system. This can be achieved by increasing the capacity of the existing surveillance system by identifying active cases early. We must ensure that we should follow “social vaccine” of proper masking, avoid indoor gatherings, and proper sanitization. Our vaccination programme needs a boost. We should vaccinate a large section of people before any third wave hits us. The more we vaccinate, the better prepared we are. As medical professionals, it must be ensured that proper scientific protocol must be implemented while handling Covid-19 cases. And last but not the least efforts must be made to fill up vacancies seen in our public health system, especially for frontline healthcare workers. As it is anticipated that the young children are more vulnerable to the forthcoming third wave, efforts are to be sought in order to start vaccination of the younger children in our country. Trials for which has already been started in India and across the world. Till the time vaccine is made available, the resources are to be mobilized to build up healthcare facilities catering the vulnerable age group in this third wave such as building up of more paediatric wards, paediatric ICU’s , training of healthcare personals in handling the emergencies for expected third wave .In addition to these efforts , more and more paediatric covid care centers must be set up at various parts of the country. Equally important is making arrangements for rehabilitation centers for the orphans. Countries like US, Singapore and UAE have already started vaccinating the children in age group between 12 to 15 years with Pfizer-BioNTech Covid vaccine. It’s a high time that the government in India must consider for allowing “expedited approval pathway” to the companies like Pfizer for their Covid-19 vaccine for children. All these combined efforts from everyone may ensure that the country and world may remain well equipped against these subsequent waves of this deadly virus and pave the path of the triumph in the near future.

Role of Aminophylline Intravesical Instillation on Enhancing Ureteral Dilatation prior to Ureteroscopy

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed Mohamed Saafan ◽  
Mohamed Ismail Shabayek ◽  
Marwa Mamdouh Mohamed ◽  
Mostafa Mabrouk Bayomi Ali
Keyword(s):  
Intravesical Instillation ◽  
Controlled Study ◽  
P Value ◽  
Pressure Monitor ◽  
Post Operative Pain ◽  
Significant Difference ◽  
Before And After ◽  
Group A ◽  
Ureteral Dilatation ◽  
Group B

Abstract Background Semi-rigid uretroscopy (URS) is a common intervention approach for lower ureteric stones. Ureteral dilatation is frequently needed before URS to enable ureter accessing. Aminophylline is known by its muscle relaxant effect and has been suggested to be effective in ureteral dilation. Objectives To evaluate the effect of intravesical administration of aminophylline on ureteroscopy and to measure intraureteral pressure Methods This prospective randomized controlled study included 50 before and after aminophylline injection. patients with lower ureteral calculi. In group A, the ureter was dilated by intravesical aminophylline whereas in group B balloon dilator was used. Intraureteral pressure was measured using pressure transducer connected to invasive pressure monitor. Results No statistically significant difference was noticed between both groups in operative time, intra operative complication, need for ureteral stenting or stone free rate. However, post-operative pain and haematuria were statistically significantly higher among balloon group compared to aminophylline group. In group A, there was statistically significant decrease in intraureteral pressure after injection of aminophylline (7.80 ± 1.71) compared to before injection (12.2 ± 1.85) with p-value &lt; 0.001. Conclusion Aminophylline is effective in ureteral dilatation when intravesically injected with less frequent post-operative pain and hematuria.

Clinical trial to assess role of ketamine in post operative analgesia after laparoscopic cholecystectomy

2021 ◽  
Vol 23 (05) ◽  
pp. 421-432
Author(s):  
Dr. Mohammad Kheiri Mahmod ◽  
◽  
Dr. Bashar Naser Hussein ◽  
Dr. Ammar Hamid Hanoosh ◽  
◽  
...  
Keyword(s):  
Clinical Trial ◽  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Analgesic Effect ◽  
Analgesic Requirement ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Significant Difference ◽  
Group A ◽  
Group B

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.

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