Effect of perioperative lignocaine infusion on postoperative pain relief for laparoscopic intraperitoneal onlay mesh repair: A randomized controlled study.

INTRODUCTION: The focus on enhanced recovery after surgery (ERAS) and opioid-free anesthesia has renewed interest in use of lignocaine. We evaluated postoperative pain relief following intravenous (IV) lignocaine administration in patients undergoing laparoscopic intraperitoneal onlay mesh repair (IPOM). METHODS: Seventy patients were randomized into two groups. Group L patients were administered IV lignocaine infusion (1.5 mg/kg) at induction of anesthesia followed by infusion (1.5 mg/kg/h), until 1 hour in the post-anesthesia care unit (PACU). Group P patients received equal volumes of normal saline IV infusion. We recorded hemodynamics, perioperative analgesic consumption, postoperative visual analog scores (VAS), incidence of postoperative nausea and vomiting (PONV), bowel function, patient satisfaction and length of hospital stay (LOS). RESULTS: The hemodynamics in both groups were maintained. Group L had lower VAS scores as compared to Group P (P < .05). Intraoperative fentanyl consumption in Group L was significantly less than Group P (P = .029). Group L patients scored lower on the Likert scale in comparison to the patients of Group P at 0 hour (P = .013). Recovery of bowel function as assessed by time to pass first flatus was significantly shortened by IV lignocaine (P = .001). The perioperative administration of IV lignocaine resulted in decreased postoperative analgesic requirement and greater patient satisfaction scores. CONCLUSIONS: Perioperative IV lignocaine infusion provided good pain relief, hemodynamic stability and decreased perioperative analgesic consumption. PONV incidence decreased along with an early return of bowel function, reduced LOS and improved patient satisfaction in patients undergoing laparoscopic IPOM surgery.

Gait asymmetry in glucocerebrosidase mutation carriers with Parkinson's disease.

BACKGROUND: GBA mutation carriers with PD (PD-GBA) are at higher risk of cognitive decline, but there is limited data regarding whether there are differences in gait dysfunction between GBA mutation and non-mutation carriers with PD. OBJECTIVES/METHODS: The primary aim of this study was to use quantitative inertial sensor-based gait analysis to compare gait asymmetry in 17 PD-GBA subjects, 17 non-mutation carriers with PD, and 15 healthy control subjects using parameters that had gait laterality and were markers of bradykinesia, in particular arm swing velocity and arm swing range of motion and stride length. RESULTS: Arm swing velocity was more symmetric in PD-GBA subjects vs. non-mutation carriers in the OFF state (12.5 +/- 8.3 vs. 22.9 +/- 11.8%, respectively, p = 0.018). In the ON-medication state, non-mutation carriers with PD, but not PD-GBA subjects, exhibited arm swing velocity (16.8 +/- 8.6 vs. 22.9 +/- 11.8%, p = 0.006) and arm range of motion (26.7 +/- 16.3 vs. 33.4 +/- 18.6%, p = 0.02) that was more asymmetric compared with the OFF-medication state. CONCLUSIONS: In the OFF medication state, arm swing velocity asymmetry may be a useful parameter in helping to distinguish GBA mutation carriers with PD from non-mutation carriers.

Comparison of Surgical Pleth Index-guided analgesia using fentanyl versus conventional analgesia technique in laparoscopic cholecystectomy.

BACKGROUND: Surgical Pleth Index (SPI) is an objective index and reflects the patient's nociception-antinociception balance during surgery. There are few studies on clinical implication of use of SPI in laparoscopic surgery. The aim of this study was to compare fentanyl requirement using SPI guided administration versus conventional analgesia technique in laparoscopic cholecystectomy. METHODS: One hundred forty patients of ASA physical status I and II, scheduled to undergo laparoscopic cholecystectomy were randomly allocated to SPI group and control group. In SPI group, fentanyl boluses of 0.5 mcg/kg were administered to keep SPI between a range of 20 to 50. In control group, fentanyl boluses 0.5 mcg/kg were given whenever heart rate or mean arterial pressure rose 20% above baseline. Intraoperative heart rate, blood pressure, fentanyl requirement, duration of surgery and recovery time were noted. SPI was monitored only in SPI group. Postoperative Visual Analog Scale (VAS) score, fentanyl requirement, postoperative nausea, vomiting and respiratory depression were recorded. RESULTS: Mean intraoperative fentanyl consumption was significantly higher in SPI group as compared to control group (169±47.2 vs. 151±39.34, P=0.017). Hemodynamic changes and recovery time were comparable in both the groups. Post-operative VAS and adjuvant fentanyl consumption were significantly higher in control group as compared to SPI group (P<0.05). PONV and respiratory depression were comparable in both the groups. CONCLUSIONS: Higher doses of fentanyl are required intraoperatively with lesser postoperative rescue analgesic requirements when SPI is used to guide intraoperative analgesia as compared to conventional analgesia technique.

Added diagnostic utility of PET in a patient with subacute encephalopathy and small-cell lung cancer.

Diagnosis of paraneoplastic neurologic disorder (PND) synthesizes the clinical picture (including the temporal relationship to the cancer diagnosis), detection of onconeural antibodies and exclusion of alternative causes. The mainstay of brain imaging of PNDs is MRI. There is also an increasingly recognized role of PET using radiotracer 18F-Fluorodeoxyglucose (FDG) in the evaluation of the brain. We describe a 67-year-old female with a 50-year smoking history and small-cell lung cancer developing subacute encephalopathy with MRI and PET abnormalities identifying paraneoplastic encephalitis. PET may complement conventional tools in diagnosing a subset of patients with PND.

ProSeal laryngeal mask airway™ insertion in the prone position: Optimal utilization of operation theatre personnel and time?

BACKGROUND: Positioning an anesthetized patient prone is challenging with regard to manpower requirement, time to surgical readiness and airway management. The ProSeal laryngeal mask airway™ (PLMA) is emerging as a suitable alternative, both as a primary and a rescue airway device to the tracheal tube (TT) for patients undergoing surgery in the prone position. MATERIALS AND METHODS: In this prospective randomized study, 70 patients scheduled to undergo pilonidal sinus excision in prone position were allocated to two groups of 35 patients each, depending on the position of the patient at induction and device placement: Group S (device placed while supine) and Group P (device placed while prone). We compared the manpower requirement, time to surgical readiness, efficacy and safety of the PLMA for airway management in the two groups. RESULTS: The number of personnel [5 (4-6) vs. 3 (3-3); P < 0.001] required for positioning the patient and surgical readiness time (22.1 ± 3 vs. 5.9 ± 0.9 min; P < 0.001) was higher in group S. There was no difference between the two groups with regard to efficacy and safety of the PLMA. Incidence of blood on the PLMA cuff and sore throat was comparable in the two groups (P = 1.000). CONCLUSION: We conclude that induction and placing the PLMA in the prone position by experienced users require fewer personnel and reduces surgical readiness time.