Assessment of Effect of Port Site and Intraperitoneal Instillation of Bupivacaine in Reduction of Post-Operative Pain After Laparoscopic Cholecystectomy

Introduction: Effective postoperative pain control is anessential component for care of surgical patients. Inadequatepain control may result in increased morbidity or mortality.Analgesic effects of periportal infiltration of local anesthetics,infiltration of periportal parietal peritoneum, intraperitonealspraying at subdiaphragmatic space and subhepatic spacecovering the area of hepatoduodenal ligament have beenreported. The present controlled study is aimed at assessingthe effect of port site injection and intraperitoneal instillation ofbupivacaine in reduction of post-operative pain afterlaparoscopic cholecystectomy.Materials and Methods: The present study was conductedamong a group of 180 patients diagnosed to have symptomaticcholelithiasis and who underwent elective laparoscopiccholecystectomy under General Anaesthesia. In group 1, preincisional local infiltration of 20ml 0.5% bupivacaine at the portsites and in group 2, local infiltration of 20ml 0.5% bupivacaineat the port sites with intraperitonial installation were given. Ingroup 3, no local infiltration was done and was treated ascontrol group. Pain assessment is based on a Universal PainAssessment Tool. The analysis of our study was performedone way ANOVA & Post HOC test (Scheffe’s HSD) & Chisquare tests as and when indicated.Results: Mean pain scores at 30 minutes were significantlylower in group 1 & 2 compared to control group but howeverthe values were not significantly different when compared toeach other. Similarly the mean pain scores at 4th, 8th, 16th and24th hours for the preincisional and preclosure group, does notsignify any inter group advantage. Therefore, bupivacaineprovide a substantial reduction of pain intensity upto 24 hourspostoperatively and was found to be statistically significant.However, timing of anesthesia was found to be statisticallyinsignificant in terms of preclosure vs pre incisional of the portsites.Conclusion: To conclude, instillation of bupivacaine at the portsites in laparoscopic cholecystectomy irrespective of the timingof instillation is an effective method of achieving pain control inthe post-operative period as long as 24 hours after surgery.There was no statistically significant reduction of post-operativepain between the preincisional and pre closure group.

A prospective single blinded randomized study to assess post operative analgesia using ultrasound guided transverse abdominis plane block for laparoscopic appendectomy

Introduction: Pain is one of the most important factors that is responsible for many adverse outcomes during surgery and in postoperative period. Effective pain control can also facilitate rehabilitation and accelerate recovery from surgery. Aim: To compare ultrasound-guided TAP block versus patients receiving no Transverse abdominis plane (TAP) block as regards the degree of pain relief in patients undergoing laparoscopic appendectomy. Materials and methods: Prospective single blinded randomized control study. Patients were randomly allocated (computer coded sealed envelopes) to receive either TAP block or no TAP block with regular analgesia. Patient will be observed for 24 hours post operatively. 60 patients divided equally into 2 groups cases were TAP (transverse abdominis plane block) group (n =30), Control group (n= 30). Results: The age between the two groups was analysed using student-t-test , the average age group in control group was found to be 32.64 years and TAP group 29.4 years. There was no significant difference in age between the two groups. The percentage of Males in TAP group was more when compare with Control, whereas in Control group the females were more but the difference was not PSV Rama Rao, M. Vijayakanth, Mohammad Feroz. A prospective single blinded randomized study to assess post operative analgesia using ultrasound guided transverse abdominis plane block for laparoscopic appendectomy. IAIM, 2016; 3(11): 103-111. Page 104 statistically differ. Pain score between two groups was analysed using Maan-Whintney U test. The pvalues of the Mann-Whitney U-test for the 2nd, 6th and 12th hours showed significant (p value – 0.000), which revealed that the mean rank for the pain scores of Control group was significant greater than the TAP group. Whereas for the 24th hour the mean rank for the pain score for both the groups were almost similar. Conclusions: Ultrasound guided TAP block with 0.375% ropivacaine bilaterally can be used effectively for post operative analgesia for patients undergoing laparoscopic appendectomy.

The measuring the quality of life index within the palliative care patients / Шинэ санаа Шинэ нээлт

Palliative medicine deserved to improve quality of life of patients with advanced, incurable diseases. During last 13 years palliative care workers tried to palliate the pain, physical, psychological, spiritual symptoms of suffering, but they never measured the quality of life of palliative care patients. The term quality of life is used to evaluate the general well-being of individuals and societies. 111 countries of the World established Country QOL Index. Quality of life should not be confused with the concept of standard of living, which is based primarily on income, should not be confused with quality of health services, which is based on medical supplies, equipment, quality of medicine, education level of health workers. Health related quality of life (HRQOL) is “The degree to which a person enjoys the important possibilities of his or her life”. Health related quality of life index not established for all medical specialties. Some tools for measuring quality of life established for diabetic patients (DQOL), cancer patients (Ca QOL), HIV patients (HIVQOL), and palliative care patients (Pa QOL). In Mongolia since 2000 started to talk about quality of services and in 2008 started program on quality of health services, but never provided study of health related quality of life of any patientTo provide the study of quality of life index within palliative care patients and compare quality of life index with pain score and score of other physical, psychological, spiritual suffering of palliative care patientsWe provided study of quality of life index within 60 palliative care patients by MISSOULA-VITAS®- 15 quality of life index, pain score by Wong Baker scale, symptoms of suffering by Anderson method, functional activities by Karnofsky performance scale, psychological problems by hospital anxiety scale23.3% of patients were up to 45 years old, 76.6 % were older 45. 70% of palliative care patients in our study were patients with cancer, 30% were palliative care patients with non cancer pathology. The mean Quality of life Index of total palliative care patients was 37.7. They had more common symptoms of suffering, like pain (90%), fatigue (83.3%), weight loss (83.3%), poor appetite (66.6%), thirst (66.6%), nausea (53.3%), constipation (60%)., depression (66.7%) and anxiety (70%). 56.6% of palliative care patients had spiritual suffering because of false hope, lost of meaning, relationship problems, and forgiveness. Increasing the score of symptoms of physical, psychological, spiritual and social suffering correlated to decreasing the quality of life index.We need to develop comprehensive palliative care to improve quality of life palliative care patients.

Intrathecal morphine plus general anesthesia in cardiac surgery: effects on pulmonary function, postoperative analgesia, and plasma morphine concentration

OBJECTIVES: To evaluate the effects of intrathecal morphine on pulmonary function, analgesia, and morphine plasma concentrations after cardiac surgery. INTRODUCTION: Lung dysfunction increases morbidity and mortality after cardiac surgery. Regional analgesia may improve pulmonary outcomes by reducing pain, but the occurrence of this benefit remains controversial. METHODS: Forty-two patients were randomized for general anesthesia (control group n=22) or 400 µg of intrathecal morphine followed by general anesthesia (morphine group n=20). Postoperative analgesia was accomplished with an intravenous, patient-controlled morphine pump. Blood gas measurements, forced vital capacity (FVC), forced expiratory volume (FEV), and FVC/FEV ratio were obtained preoperatively, as well as on the first and second postoperative days. Pain at rest, profound inspiration, amount of coughing, morphine solicitation, consumption, and plasma morphine concentration were evaluated for 36 hours postoperatively. Statistical analyses were performed using the repeated measures ANOVA or Mann-Whiney tests (*p<0.05). RESULTS: Both groups experienced reduced FVC postoperatively (3.24 L to 1.38 L in control group; 2.72 L to 1.18 L in morphine group), with no significant decreases observed between groups. The two groups also exhibited similar results for FEV1 (p=0.085), FEV1/FVC (p=0.68) and PaO2/FiO2 ratio (p=0.08). The morphine group reported less pain intensity (evaluated using a visual numeric scale), especially when coughing (18 hours postoperatively: control group= 4.73 and morphine group= 1.80, p=0.001). Cumulative morphine consumption was reduced after 18 hours in the morphine group (control group= 20.14 and morphine group= 14.20 mg, p=0.037). The plasma morphine concentration was also reduced in the morphine group 24 hours after surgery (control group= 15.87 ng.mL-1 and morphine group= 4.08 ng.mL-1, p=0.029). CONCLUSIONS: Intrathecal morphine administration did not ...

A prospective, double blind, placebo controlled, clinical trial comparing the effect of intrarectally applied and periprostatically injected lidocaine on the pain scores of patients undergoing transrectal ultrasound guided prostate biopsy

Background: Transrectal ultrasound guided prostate biopsy has placed a role in the urologist armamentarium. Considered as a minor procedure, TRUS guided prostate biopsies has currently been performed without any anesthesia. Recent studies have observed that prostate biopsy is perceived as painfulObjective: A. To compare the effect of intrarectal lubricant gel application, intrarectal lidocaine gel application and periprostatic lidocaine injection on the pain scores of patients undergoing transrectal ultrasound guided prostate biopsy. B. To determine the differences in morbidity after the procedureMaterials and Methods: From January 2004 to August 2004, 100 men underwent prostate biopsy at a tertiary hospital. Patients were distributed into 3 groups (control, lidocaine gel, lidocaine injection). A visual analog scale was used to assess the pain score. The Shapiro-Wilk test was performed on all epidemiologic data as well as on the patients pain scores. Statistical analysis used includes analysis of variance for age and Kruskal-Wallis test for PSA level, prostate volume and pain score. Tukey and Mann Whitney U test were subsequently doneResults: Ultrasound guided prostate biopsy was done in 100 cases. There were no statistical difference as to age, PSA level and prostate volume between the 3 groups. There was no statistical difference in the pain scores of patients after intrarectal lubricant gel application and intrarectal lidocaine application. (4.933 versus 4.250, p 0.1375). However, there was a statistical difference in the pain scores of patients after intrarectal lidocaine gel application and periprostatic injection (4.250 versus 2.158, p 0.0001) and intrarectal lubricant gel application and periprostatic injection (4.933 versus 2.158, p 0.0001)Conclusions: Periprostatic lidocaine injection effectively lowers the pain scores of prostate biopsy than those who received lidocaine gel or lubricant gel. Improvement in patient tolerance permits the number of biopsy cores to be increased as necessary without increasing patient distress. Routine use of local anesthesia in the formed of periprostatic lidocaine injection is highly recommended in future biopsies