RESUMEN
Objective To investigate the effectiveness and safety of acetaminophen combined with ketorolac tromethamine in pain management early after laparoscopic cholecystectomy(LC).Methods Ninety patients with LC under general anesthesia,42 males and 48 females,aged 18-78 years,BMI 18-28 kg/m2,ASA physical statusⅠorⅡ,were selected and randomly divided into two groups by random num-ber table method:the acetaminophen combined with ketorolac tromethamine group(group AK)and the nal-buphine group(group NA),45 patients in each group.Group AK received 500 mg(diluted to 50 ml)of acetaminophen injection and 30 mg of ketorolac tromethamine(diluted to 10 ml)injection pumped 15 mi-nutes before induction of anesthesia,and group NA received 50 ml of NS injection and 0.2 mg/kg of nalbu-phine(diluted to 10 ml)injection pumped at the same time.Postoperative pain was recorded 0.5,3,6,12,and 24 hours after surgery using VAS pain scores(the non-inferiority boundary Δ = 1.0 score).The sleep quality score on the night of surgery,the number of remedial analgesia cases within 24 hours after sur-gery,the Ramsay sedation score 0.5,3,and 6 hours after surgery,the occurrence of adverse reactions such as nausea and vomiting within 24 hours after surgery,and the overall satisfaction of patients were recorded.Results Compared with group NA,the VAS pain scores 0.5 hour after surgery was reduced in group AK(P＜0.05).The sleep quality score and overall satisfaction in group AK were significantly higher than those in group NA(P＜0.05).There were no significant differences in the rate of remedial analgesia,the score of Ramsay sedation at different time points and the incidence of nausea and vomiting within 24 hours after surgery between the two groups.Conclusion Acetaminophen combined with ketorolac tromethamine is not less effective than nalbuphine in relieving early postoperative pain after laparoscopic cholecystectomy without increasing the incidence of nausea and vomiting.Patients receiving acetaminophen combined with ketorolac tromethamine have higher sleep quality scores on the night of surgery and overall satisfaction.
RESUMEN
This paper reports 6 cases of cholecystitis with cholelithiasis whose calot triangles were thickened and hardened by fibrous tissue among 200 cases treated by laparoscopic cholecystectomy (L. C). The condition is different from common pathological adhesion by replacement of the structures in the calot triangle by hardened and contracted lumpish mass,and the normal anatomy disappears. LC in such condition is very difficult. Three patients were transfered to laparotomy. Three other patients underwent LC after a special effort which required a time comsuming process. The authors suggest that a special term as "Calot Triangle Lumpish Fibrosis" shpuld be given to this special condition and suggest that it is a relative contraindication for LC.