Intraperitoneal lidocaine for postoperative pain relief after laparoscopic ovarian drilling

To evaluate the efficacy and safety of intraperitoneal installation of lidocaine as regards postoperative analgesia after laparoscopic ovarian drilling for polycystic ovarian syndrome [PCOs]. A prospective, randomized placebo controlled study. Setting department of Obstetric and Gynecology, maternal health center, Assuit University, Assuit, Egypt. This study was done upon fifty women undergoing operative laparoscopic ovarian drilling for polycystic ovarian syndrome [PCOs] under general anaesthesia, all patients were subjected to skin infiltration of 2.5 ml of lidocaine 2% at the site of Verres needle and trocar insertion. Patients were allocated randomly to one of two groups; group A [lidocaine group] 25 patients received 150 mg intraperitoneal lidocaine hydrochloride in the Douglas pouch, 50mg before CO[2] inflation and 100mg left in the peritoneal cavity, and the group B [control group] 25 patients received only saline [0.9% NaCl] instead of lidocaine. Shoulder and pelvic pain were evaluated using visual analogue score, postoperative analgesic requirements [the need for intramuscular non steroidal anti-inflammatory drugs, ketorolac 30], and time to return to normal daily activities were evaluated in the ambulatoiy unit and after discharge during the first 48 postoperative hours, The collected data were analyzed using SPSS [statistical package for social science] program and Chi square test [the probability of error P]. Pain score, analgesic requirements and time to return to normal daily activities were significantly reduced in patients who received intraperitoneal lidocaine [P <0.05]. Intraperitoneal installation of 150 mg lidocaine is simple to use, resulting in effective long lasting analgesia and improves the postoperative course

Clinical and pathological factors affecting gallstone formation

The differential clinical and pathological factors which may effect gall stone formation were studied in 86 patients with gallstones and underwent cholecystectomy. Multiparity was a common feature in 66 women and oral contraceptive were used by 57 women. High caloric diet as sugars in juices, jam, honey, fruits and other carbohydrates constituted the main items of their daily diet. Cigarette smoking, diabetes, genetic predisposition and previous surgery were present in a minority of patients and could not be considered as risk factors of gall stones. Out of 14 patients, cholesterol stones were presented in 14.3%, pigment stones in 35.7% and mixed stones in 50% of patients. Pathological changes in the liver [non-specific, bilharzial, viral] and in the wall of gallbladder may add to the risk