The Effects of Intraperitoneal Local Anesthetics on the Postoperative Pain Relief in Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: Although pain after cholecystectomy was reduced significantly since the advent of laparoscopic surgery, many patients still complain of moderate pain after the surgery. Recently intraperitoneal instillation of local anesthetics is known as safe, simple, and effective method of treatment for pain after laparoscopic cholecystectomy. METHODS: Three groups are randomized; group I (normal saline 80 ml), group II (0.5% lidocaine 80 ml+1:400,000 epinephrine) and group III (0.125% bupivacaine 80 ml+1:400,000 epinephrine). Local anesthetics are instilled via subdiaphragmatic trocar hole just after creation of carboperitoneum. Visual analogue scale (VAS), total used analgesics amount, time to first analgesics request, time to out of first flatus and complications are compared. Lidocaine blood concentrations are checked in five cases of the patients after lidocaine instillation. RESULTS: The VAS was insignificant among groups except 3 hr, 6 hr postoperatively. Time to first analgesics request are prolonged in lidocaine and bupivacaine group. Used analgesics amount are significantly less in lidocaine group than control group. Time to out of first flatus was significantly shorter in bupivacaine group. No significant complications were noted. The blood concentration of lidocaine were variable and the highest concentration in five of one case was 1.8 microgram/ml. CONCLUSIONS: Although intraperitoneal instillation of local anesthetics is simple, safe method for controlling pain after laparoscopic cholecystectomy, it is not so much effective because of dilution with irrigating saline and suctioning intraoperatively and postoperative scavenging by evacuator.

Comparison of Sodium Nitroprusside and Esmolol Induced Hypotension for Total Hip Arthroplasty / 대한마취과학회지

BACKGROUND: Esmolol is a short acting sympathetic beta receptor antagonist, and it was successfully applied to induced hypotension. Esmolol lowers blood pressure by decreasing cardiac output, and does not cause vasodilation. This property of esmolol may help to decrease bleeding during induced hypotension. In this study, we tried to elucidate the effect of esmolol on induced hypotension for total hip arthroplasty. METHOD: Twenty patients receiving total hip arthroplasty were randomly divided to two groups. Esmolol group (10 patients) received esmolol as a hypotensive agent, and sodium nitroprusside (SNP) group (10 patients) received SNP as a hypotensive agent. We measured arterial blood gas analysis, vital sign, amounts of bleeding, amounts of transfusion and administered fluid, and various laboratory findings. RESULTS: Induced hypotension was successfully performed in either esmolol and SNP group. Heart rate increased by SNP, and decreased by esmolol. There were no statistically significant differences between the two groups in amounts of bleeding, amounts of transfusion or administered fluid, and laboratory findings. Arterial oxygen tension was relatively constant in esmolol group, but decreased in SNP group. CONCLUSION: Esmolol can be used as a single hypotensive agent during induced hypotension without significant side effects during total hip arthroplasty.