Preoperative Gabapentin to Prevent Postoperative Shoulder Pain After Laparoscopic Ovarian Cystectomy: A Randomized Clinical Trial.

BACKGROUND: Patients undergoing gynecology laparoscopy frequently experience shoulder pain as a common postoperative complication. Considering diaphragm stimulation in its pathophysiology, there are some advice to prevent or control this special form of referral pain. OBJECTIVES: The current study aimed to assess the prophylactic effect of preoperative administration of oral gabapentin to prevent Post Laparoscopic Shoulder Pain (PLSP) after laparoscopic ovarian cystectomy. PATIENTS AND METHODS: In a randomized, double blind, placebo controlled trial 40 female patients who were candidates to have elective laparoscopic ovarian cystectomy, received uniformed capsules containing gabapentin 600 mg or placebo 30 minutes before anesthesia induction. All patients had the American Society of Anesthesiologists (ASA) Physical Status of I-II and none had pervious abdominal surgery. Thereafter, the presence of side effects and PLSP and its severity was assessed by Visual Analog Scale (VAS) in the beginning of surgery and 2, 6, 12 hours after the surgery. RESULTS: Comparing the gabapentin (n = 20) and placebo (n = 20) groups, basic characteristics including age (P = 0.446), Body Mass Index (BMI) (P = 0.876), pregnancy history (P = 0.660), and surgery time (P = 0.232) were statistically similar. PLSP occurrence was less frequent in the gabapentin group (45%) compared with the placebo group (75%) (P = 0.053), while In gabapentin group the VAS scores were lower in 2(P = 0.004), 6 (P = 0.132), and 12 (P = 0.036) hours, post operatively. CONCLUSIONS: Prophylactic gabapentin administration could be considered as an effective and safe intervention to reduce occurrence and severity of PLSP after gynecologic laparoscopic cystectomy.

Conservative management of cervical ectopic pregnancy: systemic methotrexate followed by curettage.

INTRODUCTION: Cervical ectopic pregnancy is among the rarest clinical conditions happening in women of reproductive age. Yet its management can cause a high rate of morbidity. Therefore, conservative treatment of this condition is a matter of debate. MATERIAL AND METHODS: Hereby we present two cases of cervical ectopic pregnancies that were managed successfully with a conservative approach. CONCLUSION: Cervical ectopic pregnancy can be managed successfully with systemic Metotroxsate followed by curettage.