ABSTRACT
Introduction: Effective postoperative pain control is anessential component for care of surgical patients. Inadequatepain control may result in increased morbidity or mortality.Analgesic effects of periportal infiltration of local anesthetics,infiltration of periportal parietal peritoneum, intraperitonealspraying at subdiaphragmatic space and subhepatic spacecovering the area of hepatoduodenal ligament have beenreported. The present controlled study is aimed at assessingthe effect of port site injection and intraperitoneal instillation ofbupivacaine in reduction of post-operative pain afterlaparoscopic cholecystectomy.Materials and Methods: The present study was conductedamong a group of 180 patients diagnosed to have symptomaticcholelithiasis and who underwent elective laparoscopiccholecystectomy under General Anaesthesia. In group 1, preincisional local infiltration of 20ml 0.5% bupivacaine at the portsites and in group 2, local infiltration of 20ml 0.5% bupivacaineat the port sites with intraperitonial installation were given. Ingroup 3, no local infiltration was done and was treated ascontrol group. Pain assessment is based on a Universal PainAssessment Tool. The analysis of our study was performedone way ANOVA & Post HOC test (Scheffe’s HSD) & Chisquare tests as and when indicated.Results: Mean pain scores at 30 minutes were significantlylower in group 1 & 2 compared to control group but howeverthe values were not significantly different when compared toeach other. Similarly the mean pain scores at 4th, 8th, 16th and24th hours for the preincisional and preclosure group, does notsignify any inter group advantage. Therefore, bupivacaineprovide a substantial reduction of pain intensity upto 24 hourspostoperatively and was found to be statistically significant.However, timing of anesthesia was found to be statisticallyinsignificant in terms of preclosure vs pre incisional of the portsites.Conclusion: To conclude, instillation of bupivacaine at the portsites in laparoscopic cholecystectomy irrespective of the timingof instillation is an effective method of achieving pain control inthe post-operative period as long as 24 hours after surgery.There was no statistically significant reduction of post-operativepain between the preincisional and pre closure group.
ABSTRACT
Introduction: Urinary stone disease is a major health problemnot only because of high prevalence but also because it affectsthe young and productive population of the society. The currentstudy was performed to assess and compare the expulsiveeffects of orally administered Afluzosin as medically expulsivetherapy for distal ureteral calculi less than 8 mm in diameterwhen administered upto 21 days after the first painfulmanifestation.Materials and Methods: A total of 60 patients with distalureteric calculi were enrolled in the study and were divided intwo groups. The control group comprised of 30 patients withdistal ureteric calculi who were given Cap. Becosule (Vitamin BComplex) (Placebo) once a day for clearance of ureteric calculiwith plenty of fluids and analgesics as and when required. Thestudy group comprised of 30 patients with distal ureteric calculiwho were given Tab. Alfuzosin hydrochloride 10 mg once aday for clearance of ureteric calculi with plenty of fluids andanalgesics as and when required. The outcome was measuredin terms of passage of calculi, no. of days taken for passage ofcalculi and no. of analgesic tablets consumed until passage.The statistical analysis was done using chi-square test forproportions and Independent samples "t" test for comparingmeans between the two groups and a p value less than 0.05indicated statistically significant difference.Results: In study group, stone was passed within 21 days ofstudy period in 26 (86.7%) subjects whereas in control group, itcould pass in only 14 (46.7%) patients thus showing asignificant statistical difference between two groups (p=0.001).Mean analgesic intake was 6.63±1.38 tablets in study groupand 8.63±3.26 tablets in control group, thus showing that themean analgesic intake was significantly high in control groupas compared to study group (p=0.009).Conclusion: In our study Patients in Alfuzosin groupdemonstrated a higher incidence of spontaneous stonepassage, more rapid stone passage and a decreased need foranalgesic. This selective α1 blocker should therefore beincluded in different schedules used worldwide, when aconservative approach to this very common urological problemis considered.