Liposomal Bupivacaine Injection for Analgesia During Minimally Invasive Supracervical Hysterectomy.

Objective: To evaluate the efficacy of intracervical injection of liposomal bupivacaine for postoperative pain control among women undergoing minimally invasive supracervical hysterectomy. Methods: A randomized double-blinded placebo-controlled trial of intracervical injection of combination liposomal bupivacaine and bupivacaine for postoperative pain among patients undergoing laparoscopic and robotic supracervical hysterectomy. Patients were enrolled between October 1, 2018 and April 30, 2019. The primary outcome was pain at 12 hours postoperatively using a numeric rating scale from zero to 10. Pain scores were also recorded pre-operatively, immediately postoperatively, at 12, 24, and 48 hours postoperatively. The secondary outcome was the number of patients who required opioid analgesic medications up to 48 hours postoperatively. Results: Sixty participants were randomized into the control (n = 30) and intervention (n = 30) groups. Pain scores were 1 and 1.75 (p = 0.89) immediately postoperatively, 3 and 3.5 (p = 0.85) at 12 hours, 3.5 and 5 (p = 0.22) at 24 hours, and 2.75 and 4 (p = 0.18) at 48 hours for the control and intervention groups, respectively. Within the first 24 hours, 10 patients in the control and 14 patients in the intervention group used narcotics (p = 0.37). From the 24 to 48 hours window, 6 and 8 patients in the control and intervention groups used narcotics (p = 0.74), respectively. Conclusion: There was no statistically significant difference in pain scores between patients receiving combination liposomal bupivacaine and bupivacaine intracervical block and those receiving placebo in the first 48 hours after surgery. There was no difference in analgesic use between the two study groups.

Reproducibility of renal volume measurement in adults using 3-dimensional sonography.

OBJECTIVES: The purpose of this study was to determine the interobserver reproducibility of renal volume measurement performed by 3-dimensional (3D) sonography. METHODS: We conducted an exploratory, quantitative, observational, and descriptive cross-sectional study. We calculated ranges, means, and standard deviations of the renal volumes obtained with 3D sonography by 2 different examiners from a sample of 30 patients. The interobserver reproducibility was assessed by calculating intraclass correlation coefficients (ICCs) and by construction of Bland-Altman plots. RESULTS: The ICC between the right 3D renal volumes obtained by examiners 1 and 2 was 0.8552 (95% confidence interval, 0.7153-0.9292), showing excellent reproducibility (P < .0001). For the left 3D renal volumes obtained by examiners 1 and 2, the ICC was 0.6411 (95% confidence interval, 0.3652-0.8135), showing average to good reproducibility (P = .0001). The Bland-Altman plots showed mean differences ± SD of -4.8% ± 23.9% between the right renal volumes obtained by examiners 1 and 2 and -2.2% ± 38% between the left renal volumes. The 95% limits of agreement between the right renal volumes obtained by examiners 1 and 2 were -28.7% to 19%, whereas those between the left renal volumes were -40.2% to 35.7%. CONCLUSIONS: Three-dimensional sonography showed good interobserver reproducibility, which was better for the right kidney. It appears necessary to establish standardized techniques for acquisition of sonographic renal volumes.