A modified open primary laparoscopic surgery port placement through umbilical tube

Background:A safe, reliable technique for primary trocar introduction is important for laparoscopic surgery. In resource-constrained settings where there is paucity of needed equipment and cost is prohibitive, a method utilizing fewer instruments will be useful.Aim:This study aims to describe a method of primary trocar introduction that utilizes any available port.Methods:A supra- or infra-umbilical incision is made into an everted tubular umbilicus. The linear alba is incised and the resultant opening bluntly developed, after which any available port is inserted using the trocar as a guide. The trocar is withdrawn while the sleeve is pushed in.Results:One hundred and three successful insertions were affected in 107 patients with age range of 1­75 years, with no significant gas leaks.Conclusion:This modified open approach is a simple and reliable way of primary port insertion. Access is gained easily in different age groups and umbilicus types

Does a wrist tourniquet improve the quality of Biers block for surgeries in the hand?

This study aims to determine the effect of a wrist tourniquet on Biers Block quality for short hand procedures. 40 patients were randomized into 2 groups. One had the intravenous lignocaine injected with a wrist rubber tourniquet in situ, While the control group had none during injection. The onset of block, sensation, motor activity, need for additional analgesia and duration of surgeries were recorded for each group and analysed statistically. 27 males and 13 females were recruited. Mean onset for the tourniquet group was 4.3minutes and 9.0 minutes for the control (p< ˂0.0000005), Visual analog Pain Scores were 0.2 for Tourniquet and 1.8 for control (p< 0.0003) at 15 minutes. Sensory and motor block scores were significantly higher at 15 minutes following anaesthetic agent administration in the tourniquet group compared to the control(p<0.05). At 30 minutes there was no statistically significant difference in the scores. There was also no difference in the need for additional analgesia in either group. It appears that the use of a wrist tourniquet shortens the onset of Biers block for hand surgeries. However, it does not improve overall block quality after 30 minutes of administration but allowed a smaller dosage to be used with fewer side effects