ABSTRACT
Objectives: Effective post-operative pain control is an essential component of care of surgical patients. Various analgesic regimens have been used to ensure adequate postoperative pin relief. We conducted this study to compare the efficacy of spinal anesthesia versus general anesthesia regarding post-operative pain following laparoscopic cholecystectomy
Methodology: After approval of the hospital ethical committee, 120 females were included in our randomized, control trial from 1 July 2015 to 31 Dec 2015. Patients were explained about the study and informed consent was signed by them or their guardians. Patients were randomly divided into two groups; in Group-A patients, spinal anesthesia was achieved with 3 ml 0.5% hyperbaric bupivacaine hydrochloride and 25 microg fentanyl. Group-B was given GA. All the patients were premedicated with IV metoclopramide 10 mg and dexamethasone 8 mg; preemptive analgesia with 0.1 mg/kg nalbuphine was done. Induction of GA was done with propofol 2 mg/kg, muscle relaxation was achieved with atracurium besylate 0.5 mg/kg. Endotracheal intubation with 6.5 or 7 mm cuffed tube was done, Visual analogue scale [VAS] was used to assess pain severity at immediate post-operative period (S-0) and at 6 hours [S-6]. Data was analyzed using SPSS version 16.0. For quantitative variables like pain score and age, mean and standard deviation [SD] were calculated. For qualitative variables like severity of pain, frequency and percentages were calculated. Chi-square test was used to measure frequency of pain between two groups. P-value < 0.05 was taken as significant
Results: The two groups did not differ in demographic profiles. At S-0, the mean score in Group-A was 2.89 +/- 2.49 [mode = 1, median 2] versus 3.83 +/- 2.56 [mode = 3, median = 3], p value 0.0364. At zero hours [S-0]; 6 [10%] patients in Group-A had no pain [VAS less than 2], 28[46.6%] patients had mild pain and 26 [43.3%] patients had severe pain. In Group-B 8[13.3%] had no pain, 20[333%] had mild pain and 32[55%] patients had severe pain. The p value was 0.947, which is statistically insignificant At S-6, the mean VAS was 6.94 [median = 7, mode = 8] in Group-A versus 6.23 +/- 2.11 [median = 6, mode = 5] in Group-B, p value 0.0277. At six hours [S-6], 31[51.6%] patients no mild pain in Group-A, 24[40%] had mild pain and 5[8.3%] had severe pain. Whereas 30 [50%] patients had no pain, 8 [13.3%] patients had mild pain and 22 [36.6%] patients had severe pain in Group-B. The p-value was 0.022, which is statistically significant
Conclusion: Our study has shown that single shot spinal anesthesia provides better postoperative analgesia in the postsurgical period. The addition of intrathecal fentanyl provides adequate analgesia, including relief from shoulder tip pain. So, spinal anesthesia can be safely used as sole anesthesia for laparoscopic cholecystectomy
ABSTRACT
Objective: To compare three doses of hyperbaric 0.75% bupivacaine and measuring time for home readiness after day care perianal surgery under saddle block anaesthesia
Study Design: Non randomized controlled trial
Place and Duration of Study: The study was conducted at the department of Anaesthesia, CMH Rawalpindi from Jun 2014 to Apr 2015
Material and Methods: In this study 90 patients who presented for perianal day care surgery, were divided in three equal groups. Group A received 7.5 mg, group B 6.0 mg and group C 4.5 mg of hyperbaric 0.75% bupivacaine. Intrathecal injection was given in L4-5 space by 25 G spinal needle in sitting position. Lithotomy position was made after five minutes. After surgery patients were monitored in recovery room. After fulfilling ambulatory and discharge criteria patients were allowed to go home with attendants. Time of intrathecal injection, assessment of above criteria and time of discharge were noted and analyzed
Results: Male patients were 85.6% and females were 14.4%. Mean time of surgery was 48 +/- 10.59 min. Mean time of discharge in minutes for group A was 235.86 +/- 49.38, for group B 217.7 +/- 42.49 and for group C 205.76 +/- 32
Time of discharge was significantly different between group A and group C [p=0.02]
While it was not significantly different between group A and group B [p=0.29] and between group B and group C [p=0.819]
Conclusion: Lower dose of hyperbaric bupivacaine can reduce the time for home readiness compared to higher dose. Time of discharge is mainly dependent on time to micturate after saddle block anaesthesia