Evaluation of preoperative duloxetine use for postoperative analgesia following laparoscopic cholecystectomy: A randomized controlled trial.

Background: The pain pattern after laparoscopic cholecystectomy (LC) is complex and distinct from postoperative pain after other laparoscopic procedures, suggesting that procedure-specific optimal analgesic management plans should be proposed. Duloxetine, a non-opioid neuromodulator, has been widely used to manage pain with dual central and peripheral analgesic properties. Aims: To assess the effect of preoperative administration of duloxetine compared to placebo on postoperative pain control in patients undergoing LC. Patients and Methods: This study was a randomized, parallel-group, placebo-controlled, double-blinded study performed on patients undergoing LC. Patients were randomly divided into two groups of 30 each on the day of surgery in the preoperative holding area, using a computer-generated random number to receive 60 mg duloxetine as a single oral dose 2 h before the procedure or placebo. The primary outcome was the difference in the mean of visual analogue scale (VAS) scores between the two studied groups, as measured by the area under the curve (AUC) of the VAS scores. Results: The derived AUC of VAS scores in the duloxetine group (757.89 ± 326.01 mm × h) was significantly lower than that calculated for the control group (1005.1 ± 432.5 mm × h). The mean postoperative VAS scores recorded at 4 and 24 h were statistically different between the study groups (p = 0.041 and 0.003, respectively). As observed in the survival curve analysis, there was no significant difference (p = 0.665) for the time until the patient's first request for rescue medications in the two groups. The frequency of postoperative nausea and vomiting (PONV) was lower in patients of the duloxetine group than that recorded in those allocated to the control group at 8 and 24-h time intervals (p = 0.734 and 0.572, respectively). Conclusion: Preoperative use of duloxetine reduces postoperative pain significantly compared with placebo. In addition, its use is associated with a reduction in PONV. These preliminary findings suggest that duloxetine could play a role in the acute preoperative period for patients undergoing LC. Clinical Trial Registration: [https://clinicaltrials.gov/ct2/show/NCT05115123, identifier NCT05115123].

The intraperitoneal ondansetron for postoperative pain management following laparoscopic cholecystectomy: A proof-of-concept, double-blind, placebo-controlled trial.

BACKGROUND: Pain after laparoscopic cholecystectomy remains a major challenge. Ondansetron blocks sodium channels and may have local anesthetic properties. AIMS: To investigate the effect of intraperitoneal administration of ondansetron for postoperative pain management as an adjuvant to intravenous acetaminophen in patients undergoing laparoscopic cholecystectomy. METHODS: Patients scheduled for elective laparoscopic cholecystectomy were randomized into two groups (n = 25 each) to receive either intraperitoneal ondansetron or saline injected in the gall bladder bed at the end of the procedure. The primary outcome was the difference in pain from baseline to 24-h post-operative assessed by comparing the area under the curve of visual analog score between the two groups. RESULTS: The derived area under response curve of visual analog scores in the ondansetron group (735.8 ± 418.3) was 33.97% lower than (p = 0.005) that calculated for the control group (1114.4 ± 423.9). The need for rescue analgesia was significantly lower in the ondansetron (16%) versus in the control group (54.17%) (p = 0.005), indicating better pain control. The correlation between the time for unassisted mobilization and the area under response curve of visual analog scores signified the positive analgesic influence of ondansetron (rs =0.315, p = 0.028). The frequency of nausea and vomiting was significantly lower in patients who received ondansetron than that reported in the control group (p = 0.023 (8 h), and 0.016 (24 h) respectively). CONCLUSIONS: The added positive impact of ondansetron on postoperative pain control alongside its anti-emetic effect made it a unique novel option for patients undergoing laparoscopic cholecystectomy.

A Descriptive Study to Assess Quality of Life in Egyptian Patients With a Stoma.

The creation of a stoma changes bodily appearance and function, which can affect quality of life (QOL). A descriptive study using the Short Form 36 (SF-36) questionnaire, an instrument that measures 8 physical and mental health concepts, was conducted to quantify QOL among patients with a stoma and to interpret how stoma creation affects their lives. Participants included a convenience sample of persons served by an outpatient surgery clinic in an Egyptian university hospital in Cairo between August 2013 and January 2015. Potential participants had to be 18 years of age or older, have undergone intestinal stoma surgery, live at home, be willing to participate, and not be hospitalized or have physical or psychological limitations that prevent them from participating in self-care. General demographic data and disease characteristics/reasons for stoma creation collected included age, gender, and marital status; stoma type, design, and duration; and stoma problems/complica- tions. Every patient completed the questionnaire individually or, if necessary, with the researcher's assistance; the interview took approximately 10 to 15 minutes. Demographic data were collected after stoma creation from the patient's medical pro les using a predesigned form. The SF-36 scores were linearly converted to a 0 to 100 scale, with higher scores indicating bet- ter QOL; scores were considered excellent (100), very good (84-99), good (61-83), fair (25-60), and poor (0-24). Data were analyzed using descriptive analysis. Independent sample t-tests and 1-way analysis of variance tests were used to compare variables, and a 2-tailed probability value of 0.05 was used to determine the level of signi cance. Mean age of the 96 par- ticipants was 44.12 ± 12.83 years, and most participants were male (58.33%), married (87.5%), and had a permanent stoma (60.42%) with mean stoma duration of 2.86 ± 0.43 years. The majority of patients (68.75%) had a colostomy. All patients (100%) reported 1 or more problems related to their stoma, including nding privacy to empty the pouch (51), problems with leakage (37), the need to adapt their clothing (69), local skin irritation (28), the presence of offensive odor and/or bowel noise (90), and dif culties participating in social activities (72). Most of the QOL subscales were in the fair QOL category range (between 49.55 ± 31.59 and 59.54 ± 30). Compared to persons with a temporary stoma, participants with a permanent stoma had signi cantly higher physical role function scores (38.76 ± 33.30 versus 70.92 ± 35.59; P %lt;.05). Patients with a stoma constructed due to trauma had higher general health scale scores than persons with a stoma constructed due to in ammatory bowel disease or colon cancer (mean [SD] 61.6 ± 31.75, 57.14 ± 26.26, and 46.55 ± 30.85, respectively; P <.05). Ostomy-speci c QOL studies are needed to increase understanding about the needs of stoma patients in Egypt; the results of this study suggest their QOL is not good and improvements in proper perioperative counseling and specialized nursing care may be needed.

EVALUATION OF PACKING THE RESIDUAL CAVITY AFTER TOTAL OR PARTIAL CYST RESECTION IN MANAGEMENT OF HEPATIC HYDATID CYSTIC DISEASE.

Hydatid disease is a worldwide zoonosis caused by the larval stage of the echinococcus tapeworm, that is endemic in many parts 6f the world (in Europe, Middle East, Mediterranean, South American and African countries). Hydatid disease is a relevant health problem in underdeveloped areas where veterinary control does not exist. The most frequent location of hydatid cystic lesions is the liver (up to 80% of cases), followed by the lung (about 20% of cases), and with a lower reported incidence in any other organ or tissue in the body. Currently, surgical operation remains the treatment of choice in hydatidosis. Many surgical options can be done for management of the cyst, ranging from unroofing of the cyst, pericystectomy, up to liver resection for the affected liver parenchyma site. The cyst cavity can be managed by different techniques, capitonnage, external drainage, introflexion or omentoplasty. The Omentoplasty (OP) filling technique was the method of choice for filling of the Residual -Cavity (RC). The omentoplasty filling was, done by two procedures Pedicle Omental Pack (POP), and Isolated Omental Pack (IOP); both techniques were applied for the filling of the residual cavity compared to non-filling of the re-sidual cavity after surgery, in our retrospective ,comparative multicenter study. Seventy six patients operated for hydatid cyst between January 2010 and February 2014 were analysed retrospectively. Either with or without filling of the cavity, and either the filling was with pedicle or isolated omentoplasty were used to treat the re-sidual cyst cavity. Patients were categorised into three groups to evaluate complications: without filling of the RC (GA), ouientoplasty filling with Pedicle Omental Pack (GB), and omentoplasty filling with Isolated Omental Pack (GC). The overall mortality rates were 0%. Overall morbidity rates were 57.1% for GA, and 10.3% for GB, and 7.7% for GC respectively. Mean hospital stay was 11.8 days for GA, and 8.1 days for GB, and 8.7 days for GC. The isolated omentoplasty filling technique is a safe management in the filling of the residual cavity after surgery with less operative time and same result as pedicle omentoplasty technique. Because of omentum has a high absorptive capacity and capable to fill the residual cavity, and omentoplasty was recommended (whether with pedicle or isolated omental flap) to manage patients with hydatid cyst of the liver.