Intraperitoneal and local infiltration of bupivacaine for pain relief after laparoscopic cholecystectomy

Objective: To compare the effectiveness of intraperitoneal and local infiltration of bupivacaine on pain relief in postoperative period after laparoscopic cholecystectomy. Study Design: Randomized controlled trial. Place and Duration of Study: Combined Military Hospital Multan, from Jan to Dec 2014

Material and Methods: In this study, 72 adult patients of either gender with age between 20 to 60 years having symptomatic gallstones scheduled for elective laparoscopic cholecystectomy were divided into two groups. Patients in group A received intraperitoneal and local infiltration of bupivacaine at the end of surgery. Group B was administered placebo. Postoperatively, intensity of pain was recorded by using 10 points' Visual Analogue Score at 3, 9, 12, 24 hours. A p-value

Results: In group A, there were 27 male and 9 female patients while in group B, there were 22 male and 14 female patients. Mean age was 37.75 +/- 12.49 years and 41.92 +/- 12.73 years in groups A and B respectively. The mean postoperative pain score was 8.18 +/- 1, 6.36 +/- 0.98, 4.98 +/- 1.11 and 3.89 +/- 1.11 in group A and 8.72 +/- 1.05, 6.91 +/- 0.96, 5.92 +/- 0.96 and 4.47 +/- 1.05 in group B at 3, 9, 12 and 24 hours post operatively. The difference in mean pain scores was significant; 0.0286, 0.0188, 0.0001 and 0.0258 at 3, 9, 12 and 24 hours respectively

Conclusion: Intraperitoneal and local infiltration of 0.25% bupivacaine significantly reduces the intensity of postoperative pain and analgesic requirement in the early postsurgical hours following laparoscopic cholecystectomy

Is chest tube clamping necessary before removal? an experience with 2661 cases of tube thoracostomies

Objective: The aim of this study was to evaluate outcome of chest tube removal without clamping and relying only on clinical or radiological status for removal

Study Design: Retrospective descriptive study

Place and Duration of Study: The study was conducted in CMH Rawalpindi over a period of four years

Material and Methods: All patients of tube thoracostomies during Jan 2010 to Dec 2013 were included. Sample size was 2661. 1061 intubations were done for trauma, effusions and pneumothoraces, 905 in thoracostomies, 443 in VATS procedures like decortications, apical staplings, pleural biopsies and thymectomies and 252 in miscellaneous procedures such as open pleural biopsies, thoracoplasties and chest wall resections and reconstructions. Chest tube removal was based on absence of air bubbling in chest bottle, clinically or radiologically expanded lung, less than 6 cm excursion of column of chest tube and fluid output of <50ml [pus] and <100ml [clear fluid]. It was ensured in all cases that chest tube was not blocked and all tubes were removed by a thoracic surgery trainee. Chest tube was not clamped in any patient before removal to see respiratory distress

Results: Tube thoracostomies were performed in a vast variety of procedures. 1940 [72.9%] were males and 721 [27.1%] were females. Mean age was 37 years. In 1529 [57.4%] intubation was done on the right side. In 34 [1.27%] there was recurrent fluid collection. Recurrent pneumothorax was seen in 18 [0.67%] while tension pneumothorax was seen in 4 [0.15%]. Collective complication rate was in 56 [2.1%]. There was no mortality

Conclusion: Current worldwide practice of clamping chest tube before removal to judge respiratory distress can be challenged by our study. Emphasis is laid on clinical judgment, absence of air leak and minimal excursion sign of well expanded lung before removal of chest tube

Frequency of anomalies associated with chest deformity in physically fit male candidates reporting for military recruitment

To identify the frequency of anomalies associated with chest deformity in physical fit male candidates reporting for military recruitment. Observational. Department of Thoracic Surgery, CMH Rawalpindi from 1[st] Jan 2008 to 31 Dec 2011. Normal healthy physically fit young adolescents being recruited for army were scrolled and those exhibiting chest deformity were isolated and subjected to evaluation. Convenience sampling was carried out. All cadidates of chest wall deformity thereafter underwent a thorough physical checkup, pulmonary function tests and echocardiography. A total of 3735 candidates of chest deformity reported at our center for evaluation over this duration. Single deformity patients 3380 [90.5%], mixed deformity patients 355 [95%]. We found that none of the candidates had any derangement of the lung function tests or electrocardiographic abnormality despite their deformity. However echocardiography detected an abnormality in 161 [4.3%] individuals who were otherwise asymptomatic. Chest deformity should be excluded before physical tests, in all the male candidates reporting for enrolment. If slightest of doubt exists that a candidate has chest deformity then he should be evaluated with echocardiography to exclude cardiac abnormality. Although the associated frequency is only 4.3% but this can subsequently result in a grave event like death

experience of corrective surgery of 37 cases of chest deformity

The study was carried out to ascertain the cosmetic outcome of corrective surgery for pectus deformity and to determine the morbidity associated with it. Quasi-experimental study. The study conducted in CMH Rawalpindi and CMH Quetta from 2007 to 2012. Total number of cases operated for chest deformity was 37. Modified Welch procedure with sub perichondrial resection was done with a strut of prolene mesh in a majority of exacavatum repairs and k wires in few. Pectoroplasty was subsequently carried out in all patients. Midline incision was made in a majority of patients. Subjmammary incision was made in some female patients with a lower deformity due to better cosmetic outcome. Inclusion criterion was patients with chest deformity without any cardiac and spinal deformity. Age range was between 4 years to 12 years with mean age of 8 +/- 2.3 years. twenty four [65%] deformities were of excavatum and 9 [24%] were of carinatum type. Four [11%] cases were of unilateral asymmetrical deformity. Mean operating time was 95 +/- 11 minutes. Transfusion was required in only 1 [3%] o the cases. There was no perioperative mortality. Four [11%] patients had formation of seroma and 3 [8%] developed pneumothorax which was aspirated without placement of chest tube. Two [5%] had surgical site infection. Fifteen [41%] patients were satisfied and 21 [57%] reported excellent results. Chest deformity correction is safe and effective procedure with acceptable cosmetic results. It is easy to perform and improves self image of the suffering individual