ABSTRACT
Background and Aims: Laparoscopy is associated with acute pain. We compared the effectiveness of intra-peritoneal dexamethasone with bupivacaine versus bupivacaine in patients undergoing laparoscopic cholecystectomy for postoperative analgesia. Methods: This randomised study was conducted after approval from the institutional ethics committee and 84 patients were randomly allocated into bupivacaine with dexamethasone group (BD) (received 40 mL of 0.25% bupivacaine with 16 mg dexamethasone), and bupivacaine group (BB) (received 40 mL of 0.25% bupivacaine intra-peritoneally). Data analysis was done using R version 4.2.1. The visual analogue scale (VAS) score, total rescue analgesic dose, and time required for the first analgesic between groups were compared using the Wilcoxon rank sum test or t-test appropriately. Results: VAS score was significantly lower in the BD group compared to the BB group until 2 h post-operatively with a mean difference of - 1.0 (95% confidence interval [CI] -1.5, -0.53), P < 0.001. The total rescue analgesic dose consumed was lower in the BD group (60.71 mg [29.80]) compared to the BB group (73.20 mg [11.57]) with a mean difference of - 12.5 mg (95% CI - 22.3, -2.68), P = 0.013. In addition, the time taken for the requirement of the first rescue analgesic was significantly longer in the BD group (417.1 min [276.0]) compared to the BB group (219.4 min [226.1]) with a mean difference of 197.7 (95% CI 75, 320), P = 0.002. Conclusion: Intra-peritoneal instillation of 16 mg dexamethasone with 0.25% bupivacaine in laparoscopic cholecystectomy significantly reduces post-operative pain and requirement of rescue analgesic compared to 0.25% bupivacaine alone.
ABSTRACT
Background and Aims: During laparoscopic surgeries, pneumoperitoneum increases intraabdominal pressure (IAP) which can increase the central venous pressure (CVP), and significant haemodynamic changes. In this study, we evaluated the effect of two different pressures of pneumoperitoneum, standard (13-15 mmHg), and low (6-8 mmHg) on the cross-sectional area (CSA) of the internal jugular vein (IJV) using ultrasonography, haemodynamic changes and duration of surgery. Surgeon's comfort and feasibility of performing laparoscopic surgeries with low pressure pneumoperitoneum was also studied. Methods: This prospective, double-blind, randomised study included 148 patients of American Society of Anesthesiologists physical status class I and II undergoing laparoscopic surgeries. They were allocated into two groups: group S (standard) (number (n) = 73) had the IAP maintained between 13-15 mmHg; group L (low) had an IAP of 6-8 mmHg (n = 75). CSA of right IJV was measured before induction of anaesthesia (T1), 5 min after intubation (T2), 5 min after pneumoperitoneum (T3), before desufflation (T4) and 5 min prior to extubation (T5). Chi-square test, and Student's paired and unpaired t test were used for statistical analysis. Results: The increase in IJV CSA at T3 when compared to T2 was statistically significant in both the groups (P < 0.001). On desufflation, the change in IJV CSA showed significant decrease in T5 value than T4 value in both the groups (P < 0.001). However, the percentage change in the IJV CSA was more in group S (35.4%) than group L (21.2%). Conclusion: CSA of IJV increased significantly even with lower IAP of 6-8 mmHg. Laparoscopic surgery can be performed conveniently even at low IAP.
