Analgesic efficacy of different postoperative analgesia in day-case diagnostic laparoscopy

This prospective randomized study was designed to compare the analgesic efficacy of intramuscular non-steroidal anti-inflammatory drug [NSAID], diclofenac sodium, intravenous tramadol and combination of the NSAID and tramadol in 45 ASA grade I and II patients scheduled to undergo day-case laparoscopic diagnosis of infertility. The patients classified into 3 groups each n=15. Group I patients received i.m diclofenac sodium 150 mg. Group II patients received i.v tramadol 1.5 mg/kg. Group III patient receive both drugs. The anaesthetic technique was standardized in all patients and at the end of surgery they received rectus sheath block with local anaesthetic.Patients in group II and III had significantly less postoperative pain in the recovery room, 60 min postoperatively and at discharge from the day-surgery unit and they required rescue analgesia with morphine less often than patient in group I. No difference in either the incidence or severity of nausea and vomiting was observed between the studied groups. The analgesic drugs were well tolerated at the dose given in the study, although dry mouth was significantly more common after administration of tramadol in group I and II. Severe nausea and vomiting was a factor necessitating overnight admission in 2,1 and 1 patients in group I, II and III respectively with no significant difference in the hospital admission rate of the three groups. The time of hospital discharge was less in group III, but no statistically significant difference was found between groups. This study had concluded that the analgesic efficacy of tramadol with rectus sheath blockade is an effective and well tolerated analgesic for day-case laparoscopic surgery than use of NSAID with rectus sheath blockade but combination at NSAID, tramadol and rectus sheath blockade was more effective and better in reducing pain and decreasing the time of hospital discharge with no statistically significant difference was found

Double-blind comparison of prophylactic antiemetic effect of ephedrine, metoclopramide and ondansetron on patients undergoing gynacologic laparoscopy: cost-effectiveness analysis

In a randomized, double-blind study, the prophylactic antiemetic cost-efficacy of epphedrine, metoclopramide and ondansetron in 100 patients undergoing general anaesthesia for day-case gynacological laparoscopic surgery were compared. A standard general anaesthetic technique was used for all patients. Ten min. before the end of surgery, patients were classified into 4 groups each [n=25]. Placebo, ephedrine, metoclopramide and ondansetron groups and they receive 3 ml saline i.m, 0.5 mg/kg ephedrine i.m, metoclopramide 10 mg i.v and ondansetron 4 mg i.v respectively. During the first two hours after anaesthesia [early vomiting], the incidence of postoperative nausea and vomiting [PONV] was 68%, 28%, 32% and 20% after administration of saline, ephedrine, metoclopramide and ondansetron respectively [P<0.05]. There was a significant difference between placebo and other groups. However there was no difference between ephedrine, metoclopramide and ondansetron groups in the incidence of PONV. During the time between 2 hours and 24 hours postoperatively [delayed vomiting], the incidence of PONV was 80%, 72%, 44% and 24% in saline ephedrine, metoclopramide and ondansetron group respectively. There was a significant difference between ondansetron group and other groups [P<0.05]. No difference in the incidence of once administration of rescue drug but there is a great difference in the incidence of twice or more administration of rescue drug between ondansetron and other groups [P<0.05]. No difference in the incidence of adverse events was observed between groups. There was a great difference in price between ondansetron and other drugs. This study was concluded that the prophylactic administration of I.V ondansetron was not superior to ephedrine and metoclopramide in preventing early PONV but only in preventing delayed PONV and its cost did not justify as for use in our country as a routine prophylactic antiemetic drug against PONV