Role of prophylactic antibiotics in low risk elective laparoscopic cholecystectomy: is there a need?

Elective cholecystectomy for symptomatic gall stone disease carries low risk of postoperative infective complications. Yet the routine use of prophylactic antibiotic is in vogue in many centres. The aim of this study was to find out the efficacy of antibiotic prophylaxis in preventing postoperative infective complications in low risk elective laparoscopic cholecystectomy patients. Randomised controlled trial was carried out in our hospital from 1[st] Nov 2009 to 15[th] Oct 2011. A total of 350 patients were included in the study and were divided into Group A [n=177], and Group B [n=173]. Group A was given single dose of injection Cefuroxime 1.5 gm as prophylactic antibiotic at the time of induction of anaesthesia, and Group B was not given any antibiotic. In both groups, age, sex, duration of surgery, American Society of Anesthesiologists classification, duration of surgery and length of hospital stay were recorded. Patients were followed-up weekly for 4 weeks and rates of superficial surgical site infections as well as intra-abdominal infections were recorded. There were no significant differences in both groups in terms of age, sex, duration of surgery, length of hospital stay. Eight [4.5%] cases of superficial surgical site infection were noted in Group A and 7 [4.0%] in Group B which was insignificant statistically [p>0.05]. In low risk patients antibiotic prophylaxis does not seem to affect the incidence of postoperative infective complications in elective laparoscopic cholecystectomy. The use of prophylactic antibiotics should be reserved for high risk patients undergoing laparoscopic cholecystectomy

Importance of clinical assessment in diagnosis of acute appendicitis and its role in decreasing negative appendicectomy rate

Appendicitis is a common diagnosis, but is by no means a simple one to establish. It is impractical to have a definitive preoperative diagnosis, which leads to an appreciable rate of negative appendicectomy as reported in world literature varying from 20-40% with its morbidity around 10%. This retrospective study investigated the value of clinical assessment and medical imaging [ultrasonography] for patients with suspected appendicitis. Negative appendicectomy rate and appendiceal perforation with or without medical imaging were used as end points for this investigation. This study reviewed all patients admitted in Sheikh Khalifa Bin Zaid Hospital with suspected acute appendicitis. The patient cohort was identified from the unit registry and review of medical records. The medical records were analysed, and the outcomes of patients were followed up. Between June 2010 to June 2012, 375 patients' medical records were audited. These included 56.3% males and 43.7% females. The negative appendicitis rate was 7.2% and appendiceal perforation rate was 5.3%. Ultrasound was done in 103 [27.4%] patients in whom diagnosis of appendicitis was doubtful. Medical imaging had a 50% prediction rate for acute appendicitis, 40% false-negative rate, and 10% false-positive rate. Overall, the prediction rate for appendicitis by clinical assessment supplemented by laboratory tests and medical imaging at clinician's discretion was 92.8%.Despite studies advocating routine use of medical imaging for patients with suspected acute appendicitis, this study showed that the clinical evaluation is still paramount to the management of patients with suspected acute appendicitis before considering medical imaging.

Acute renal colic; comparison of nelbuphine hydrochloride with diclofenac sodium during emergency management

To compare the efficacy of Nelbuphine hydrochloride [opioid] and Diclofenac Sodium [NSAID] in management of Acute renal pain. Prospective non-randomized quasi experimental study. This study was conducted in Emergency department [ED] of Combined Military Hospital, Lahore. From 1st April 2008 to 31 July 2009. A Total of 100 patients presenting in emergency department with a clinical diagnosis of renal and Ureteric colic were studied. They were randomly divided in to equal and comparable groups, Group A and B. Severity of pain was assessed using a Visual Analogue scale [VAS]. Group A was treated with Intravenous Nelbuphine 10mg and group B was given intramuscular Diclofenac Sodium 75mg. Assessment of Pain relief, both onset and complete response was assessed in both groups. In addition to the pain relief, side effects like Nausea, vomiting, respiratory depression, drowsiness and injection site pain were also assessed. Nelbuphine was found significantly superior [p=0.05] to Diclofenac, both for time of onset of pain relief and complete pain relief. Moreover less patients required rescue analgesia in Group A [p=0.05]. Only one patient treated with Group A had respiratory depression which was statistically insignificant [p=0.05]. There was a 3.5% increase in Nausea and vomiting in Nelbuphine treated patients. Nelbuphine is a safe and rapid acting Opioid with few side effects. It should be preferred over Diclofenac sodium in treatment of Acute Renal pain