Intraperitoneal and periportal injection of bupivacaine for pain after laparoscopic cholecystectomy

Purpose: to study the analgesic efficacy of intraperitoneal and periportal injection of bupivacaine following laparoscopic cholecystectomy. Materials and methods: 40 patients undergoing laparoscopic cholecystectomy were randomized into two groups of 20 each. Group A (study group) received 40 ml of intraperitoneal injection of 0.25% bupivacaine and 20 ml of same concentration in 4 ports, 5 ml each at the end of surgery. Group B (control) received no treatment. Post operative patient monitoring and pain assessment was done by another doctor blinded to the procedure using VAS score at 1,2,3,6,9 and 24 hours after surgery. Pethidine 50 mg intramuscular was given as rescue analgesic when demanded by patient within first 24 hours. Results: when VAS score was analyzed in the two groups, the study group had less scores compared to control group though it was statistically not significant (p > 0.05). The rescue analgesic requirement was significantly less in study group (p < 0.00). Conclusion: Intraperitoneal and periportal injection of bupivacaine is effective in decreasing pain after laparoscopic cholecystectomy. Key words: Laparoscopic surgery, intraperitoneal bupivacaine, analgesia, VAS score doi: 10.3126/kumj.v7i1.1765 Kathmandu University Medical Journal (2009), Vol. 7, No. 1, Issue 25, 50-53

Effects of Pneumoperitoneum during Laparoscopic Surgery in Young Children

This observational study of effect of pneumoperitoneum during laparoscopic surgery in 36 patients below 5 years of age (mean age 2.66 ± 1.23 yrs) was carried out in Combined Military Hospital, Dhaka over a period of 2 years. The aim of the study was to evaluate the effects of pneumoperitoneum in this age group. Intraabdominal pressure ceiling was fixed at 12 mm of Hg. Mean duration of pneumoperitoneum was 25 ± 3.21 minutes. Amount of CO2 absorption was assessed by rise of end tidal CO2 (ETCO2) (+21.21%). Effect of pneumoperitoneum and hypercarbia reflected by rise of pulse rate (+16.96%), systolic blood pressure (+12.19%), diastolic blood pressure (+14.58%) and pulmonary airway pressure (+25%). Oxygen saturation reduced a little bit; but came to baseline within a few minute after completion of the procedure. Electrocardiogram showed sinus rhythm in all but one patient. Requirement of postoperative analgesia was minimum. Mean hospital stay was 4±0.21 days. Postoperative side effects or complication was negligible (only two cases of postoperative vomiting). This study supports the safety and better outcome of laparoscopic technique even in young children provided there is good planning and vigilance. Key words: Laparoscopic surgery, pneumoperitoneum, children. DOI: 10.3329/jafmc.v5i2.4577 JAFMC Bangladesh Vol.5(2) (December) 2009, pp.18-20