Effect of bupivacaine on postoperative pain after laparoscopic cholecystectomy

Objective: To determine whether intraoperative local injection of 0.5% bupivacaine around port sites would decrease early postoperative pain after laparoscopic cholecystectomy, and the use of intravenous opioid analgesics postoperatively

Study Design: Randomised controlled trial.

Place and Duration of Study: Department of Surgery, Khyber Teaching Hospital, Peshawar, from July 2016 to June 2017

Methodology: Patients who underwent laparoscopic cholecystectomy were divided into two groups. Group A had instillation of 20 ml of 0.5% Inj. bupivacaine at the end of procedure into port sites and group B had no bupivacaine injection at trocar sites. Both groups had postoperative intravenous ketorolac 30 mg three times daily and intravenous opioid analgesics on demand. Pain was assessed 2 hours after recovery from general anesthesia, and at 6, 12 and 24 hours through visual analog scale 0-10

Results: One hundred and twenty patients completed this study with 60 patients in each group. A significant difference in mean postoperative pain scores was observed at 2 and 6 hours after surgery between the groups. Pain scores at 2 and 6 hours after surgery were 3.97 +/- 1.327 and 3.02 +/- 1.08 in group A, while it was 4.65 +/- 1.448 and 4.72 +/-1.277 in group B with p-values of 0.008 and 0.005, respectively. There was no significant difference in mean postoperative pain scores at 12 and 24 hours between the groups, with pain scores of 3.72 +/- 0.78 and 3.75 +/- 0.95 [p=0.488 and 0.744, respectively]. However, there was a significant difference in opioid analgesics use in first 24 hours with less analgesics use in bupivacaine injected group

Conclusion: Injecting 0.5% bupivacaine at trocar sites during laparoscopic cholecystectomy offers significant reduction in early postoperative pain

Surgical management of hepatic hydatid cyst in children

To know the effectiveness of removal of hydatid cyst of liver along with pericyst [pericystectomy] as operative treatment, in terms of intra-operative and post-operative complications in the pediatric age group. This study was conducted on paediatric patients with liver hydatid cysts at Department of Paediatric Surgery, Lady Reading Hospital, Peshawar from January 2000 to December 2006. All patients with ultrasound findings for hydatid cyst disease of the liver were included in the study. They were evaluated according to age, clinical presentation, ultrasound and CT scan findings for operative management. After Laparatomy through right transverse incision, half of the contents of the cyst were aspirated, refilled with hypertonic saline solution of the aspirated volume and after waiting for five minutes Pericystectomy was carried out, followed by careful examination and stoppage of any leakage of blood or bile from the residual cavity. In infected cases the cavity was drained. Out of 21 paediatric patients operated for liver hydatid cysts during the study period, 11[52.4%] were girls and 10 [47.6%] were boys, with age ranging from 4 to 15 years. Cystectomy with tube drainage was performed in 20 patients while in one patient de-roofing was performed because of rupture. Hypertonic saline was used as a scoliocidal agent. There was no operative mortality. The mean hospital stay was 6.5+3.8 days. Recurrence after operation was seen in one [4.8%] patient. Hepatic hydatid cysts in children can be treated successfully by peri-cystectomy

Retrospective analysis of clinical presentation of children with diagnosed intussusception

To know the presenting clinical features of intussusception in children up-to the age of twelve years. The study was conducted at the Department of Paediatric Surgery, Post-Graduate Medical Institute, Lady Reading Hospital, Peshawar, over a period of 18 months. A total of 71 patients with diagnosed intussusception were included. The relevant data, both pre-operative and postoperative, of children who were operated for intestinal obstruction and finally turned out to be suffering from intussusception, was fed into a pre-designed proforma and the information so obtained was analyzed according to objectives of the study. The common presenting features were colicky abdominal pain in 70 [98:59%] cases, vomiting in 67 [94.36%] cases, abdominal distension in 67 [94.36%] cases, constipation in 63 [88.73%] cases, bleeding per rectum in 61 [85.91%] cases, palpable mass per abdomen in 56 [78.87%] cases and fever in 18 [25.35%] cases. In 11 [15.49%] cases there was a mass palpable per digital rectal examination and 05 [07.04%] patients had diarrhoea on presentation. Colicky abdominal pain, vomiting, abdominal distention, constipation, bleeding per rectum, palpable mass per abdomen are the commonest presenting clinical features of intussusception in children