Effects of Preincisional Ketamine on Postoperative Pain after Laparoscopic Assisted Vaginal Hysterectomy

BACKGROUND: We evaluated the effect of preincisional injection of a small dose of ketamine on postoperative pain after laparoscopic assisted vaginal hysterectomy (LAVH). METHODS: Fourty patients undergoing LAVH were randomly allocated to one of two groups. Group K received ketamine 0.5 mg/kg IV. Group N received normal saline IV as a control group. Postoperative pain was rated at 1, 3, 6, 12, and 24 hr postoperatively by visual analog scale (VAS). The incidence of patients requiring analgesics in the PACU and on the ward, the time to the first analgesic request and side effects were recorded. RESULTS: At 1, 3, 6, 12, 24 hr after surgery, patients in the group K had significantly lower VAS than those in the group N (P < 0.05). The incidence of patients requiring analgesics in the postanesthetic care unit (PACU) and on the ward was not significantly different in the group K compared with group N. There were no significant differences in the first analgesic request time and the incidence of side effects in both group. CONCLUSIONS: Preincisional treatment with ketamine 0.5 mg/kg IV reduces postoperative pain after LAVH.

Laparoscopic Hysterectomy for Large Uterus:A Report of 86 Cases / 中国微创外科杂志

Objective To investigate the operative skills of laparoscopic hysterectomy of large uterus.Methods A retrospective analysis was conducted on clinical data from 86 cases whose uterus were bigger than twelve gestational age uterus and therefore treated with laparoscopic hysterectomy from February 1998 to December 2005.Among the 86 cases,12 received total laparoscopic hysterectomy(TLH),59 received laparoscopic supracervical hysterectomy(LSH),and 15 received laparoscopic-assisted vaginal hysterectomy(LAVH).The location of laparoscopy was determined to be at least 3-5 cm above the fundus of uterus.The most crucial step was the treatment of adnexa and uterine blood vessels.After blocking the uterine blood vessels,most of uterine bodies were rotarily cut in TLH and LAVH.Results All operations(86 cases)were performed successfully under laparoscopy and no severe operative complications were noticed except for 1 case of subcutaneous emphysema.The average operation time and the intra-operative blood loss were(92.3 ?33.5)min and(113 ?31)ml respectively.The average postoperative hospital stay was(4.1?0.3)days.No postoperative complication was found in all cases during the 6-month follow-up.Conclusions Laparoscopic hysterectomy of large uterus is safe and feasible,and does not increase operative risk and incidence of complications,when suitable laparoscopic location is selected and treatments of adnexa and uterine vessel are well performed.

Clinical Analysis of Laparoscopic Incidental Appendectomy / 대한산부인과학회잡지

OBJECTIVE: To evaluate the safety and efficacy of the laparoscopic incidental appendectomy during gynecologic laparoscopic operation. Methods: This study was evaluated for the clinical analysis of 118 patients who underwent laparoscopic assisted vaginal hysterectomy(LAVH group, 65 cases) and LAVH with laparoscopic incidental appendectomy(LAVH + IA group, 53 cases) at the Wallace Memorial Baptist Hospital from Oct. 1996 to Nov. 1998. RESULTS: The following results were obtained: 1) There was no significant difference between two groups in regard to age. The mean age was 45.7 years in LAVH group and 43.8 years in LAVH + IA group. 2) There was no significant difference between two groups in mean operative time. The mean operative time was 90.4 minutes in LAVH group and 97.5 minutes in LAVH + IA group. 3) The mean appendectomy time was 7.1 minutes. 4) The mean time recovering normal bowel activity was 46.2 hours in LAVH group and 45.8 hours in LAVH + IA group. There was no significant difference between two groups. 5) The mean hospital stay was 6.4 days in LAVH group and 5.7 days in LAVH + IA group. There was no significant difference between two groups. 6) The postoperative complications occurred in 11 cases(9.3 %). The serious complications of appendectomy was not found. 7) Of the 53 appendices removed, 5(9.4 %) were abnormal pathologic findings. CONCLUSION: Laparoscopic incidental appendectomy during laparoscopic operation was not found to influence the operation time, hospital stay, gas passing time, but there is one case of wound infection due to incidental appendectomy. Therefore, a large number of study should be performed to evaluate the safety and efficacy of laparoscopic incidental appendectomy during laparoscopic operation.