Comparison of mean pain scores for the patients with sub hepatic drainage to those without it after elective uncomplicated laparoscopic cholecystectomy

Objective: The sub hepatic drain is often placed after laparoscopic cholecystectomy is considered to affect post operative infection, pain and sub hepatic collections. The objective of this study was to compare the degree of postoperative pain in patients with routine drainage with those without it after elective, uncomplicated laparoscopic cholecystectomy

Methods: This randomized control trial [RCT] was done over six months from 9th June 2015 to 8th December 2015 at Military Hospital Rawalpindi. Sample calculated with WHO calculator and consecutive non probability random sampling used to divide 170 patients undergoing laparoscopic cholecystectomy in two groups. One group had routine sub hepatic drain and other didn't. Degree of postoperative pain was assessed according to VISUAL ANALOGUE SCALE by duty doctor at 24 hours. Data was collected and analyzed applying chi square test and p value was <0.05 considered statistically significant

Results: Our results demonstrated that intensity of post operative pain in routine drainage group is higher as compared to non drainage group after elective, uncomplicated laparoscopic cholecystectomy

Conclusion: Routine placement of sub hepatic drain in elective uncomplicated laparoscopic cholecystectomy should be avoided to reduce post-operative pain

Hemodynamic response of low dose bupivacaine with fentanyl spinal anesthesia in elderly patients

To determine whether a reduced dose of bupivacaine in combination with fentanyl could give reliable block with greater hemodynamic stability in elderly patients. Quasi experimental study. Department of Anaesthesiology, Intensive Care and Pain Management Combined Military Hospital Rawalpindi. One year duration, from May 2006 to April 2007. ASA I-III elderly patients [n=60] undergoing surgery for fracture neck of femur, meeting the inclusion and exclusion criteria. Sixty elderly patients were randomized in two groups. The study group [group-A] received spinal anesthesia as a combination of hyperbaric bupivacaine 7.5 mg and fentanyl 15 µgm while the control group [group-B] received hyperbaric bupivacaine 15 mg. The hemodynamic stability of the patients and the quality of the blocks were compared. All patients had adequate duration of block. There was no significant difference in the change of heart rate between the two groups. Fall in blood pressure was more pronounced in the control group [group-B] patients requiring more ephedrine as compared with the study group [group-A] patients which remained more hemodynamically stable. A reduced dose of hyperbaric bupivacaine in combination with fentanyl provides reliable spinal anesthesia in elderly patients with few events of hypotension and little need for vasopressor support of blood pressure.