Analgesic efficacy of intraperitoneal ropivacaine or combined with intravenous paracetamol for laparoscopic cholecystectomy

Intraperitoneal instillation of ropivacaine 0.25% immediately before and after surgery and intravenous [IV] administration of paracetamol at the end of surgery may reduce postoperative pain after laparoscopic cholecystectomy. The aim of the study was to examine whether intraperitoneal instillation of ropivacaine with or without IV paracetamol improves postoperative pain after laparoscopic cholecystectomy. After standardized general anesthetic, total of 60 patients were randomly assigned to one of three groups, 20 patients each. Group 1 received intraperitoneal instillation of 20 ml 0.9% saline before and after surgery and IV 100 ml 0.9% saline at the end of surgery [Placebo group]. Group 2 received intraperitoneal instillation of 20 ml ropivacaine 0.25% before and after surgery [total 100 mg ropivacaine] and IV 100 ml 0.9% saline at the end of surgery [Ropi group]. Group 3 received intraperitoneal instillation of 20 ml ropivacaine 0.25% before and after surgery and IV paracetamol 1 gm [in 100 ml bottle] at the end of surgery [Ropi-Para group]. Postoperative pain was rated at 0, 3, 6, 12, and 24 h postoperatively by visual analogue scale scores [VAS]. Total rescue analgesic consumption of morphine during the first 24 h after surgery and time until first analgesic request were recorded. Patients in Placebo group experienced visceral pain mainly and to a lesser extent incisional pain during the first 24 h after surgery. Patients in Ropi group experienced significantly less visceral pain than patients in Placebo group at 3 h after surgery [p < 0.05]. However, there was no significant difference in the intensity of the incisional pain between Ropi and Placebo group at any time after surgery. Patients in Ropi-Para group experienced significantly less visceral and incisional pain than patients in Placebo group at 3 and 6 h after surgery. Patients in Ropi-Para group experienced significantly less incisional pain than patients in Ropi group at 3 and 6 h after surgery. Also, patients in Ropi-Para group experienced significantly less visceral pain than patients in Ropi group at 6 h after surgery. Rescue morphine consumption was significantly less in Ropi-Para group [13 +/- 3 mg] compared to Placebo group [37 +/- 9 mg] [p < 0.001] and Ropi group [21 +/- 5 mg] [p < 0.05]. Also, rescue morphine consumption was significantly less in Ropi group compared to Placebo group [p < 0.05]. Time to first request for analgesia was significantly longer in Ropi-Para group [369 +/- 81 min] compared to Placebo group [35 +/- 29 min] [p < 0.01] and Ropi group [192 +/- 65 min] [p < 0.05]. Also, time to first request for analgesia was significantly longer in Ropi group compared to Placebo group [p<0.05] Intraperitoneal instillation of 20 ml ropivacaine 0.25% before and after surgery [total 100 mg ropivacaine] in addition to IV administration of paracetamol at the end of surgery provides better analgesia after laparoscopic cholecystectomy than that produced by intraperitoneal instillation of ropivacaine alone

effect of propofol versus sevoflurane based anaesthesia on the electrically evoked stapedius reflex during cochlear implant surgery in paediatrics [comparative study]

Cochlear implantation is a widely used mean of treatment in deafness and severe hearing disorders in adults, children, and infants. Postoperative fitting of the externally worn speech processor is very important for successful use of the cochlear implant. In young children, this fitting process can be difficult because of limited communication capabilities. Investigators have used electrically evoked stapedius reflex threshold [ESRT] to predict maximum comfortable loudness [MCL]. During surgery the drugs used for general anaesthesia influence the values of the stapedius reflex. This study aims to compare two anesthetic regimens that can be used during cochlear implant surgery with the least effect on the evoked stapedius reflex threshold. This prospective r and om controlled study was done on 20 patients [n=20] ASA physical status I-II, scheduled for cochlear implant surgery. According to the maintenance agent patients were allocated randomly into two equal groups, each group is 10 patients. The propofol group [group Prop.], in which patients were maintained using propofol infusion [6mg.kg[1] hr[-1]]. The other group was maintained using sevoflurane [group Sevo.] at a concentration of 2%. Intra operative stapedius reflex testing was performed after implantation of prosthesis. The stimuli were generated by the nucleus diagnostic programming interface and reflex threshold was determined by observing the contraction of stapedius muscle. Two months later the MCL value was determined The mean amplitude of electric current [in mAm] used for induction of ESRT was significantly lower in the group Prop, than that required to induce the reflex in group Sevo. Regarding the ability of the electrically elicited stapedius reflex thresholds obtained under anaesthesia to predict the MCL in the post-operative setting. It was found that this was achievable in the propofol group and not sevoflurane. Compared to sevoflurane propofol has less inhibitory effect on the ESRT. The reflex threshold obtained under the effect of propofol can serve as a guide for postoperative MCL. This was not the case while using sevoflurane.