ABSTRACT
BACKGROUND AND AIMS: Use of high dose opioids following laparoscopic surgery delays discharge from the hospital. Unlike intraperitoneal instillation, nebulization has been reported to provide a homogeneous spread of local anesthetics and provide better analgesia. In our study, we aimed to assess the efficacy of intraperitoneal nebulization of local anesthetic in alleviating postoperative pain in patients undergoing laparoscopic cholecystectomy. MATERIAL AND METHODS: This randomized control double-blinded study was conducted after obtaining approval from the hospital ethics committee and informed consent from patients undergoing laparoscopic cholecystectomy under general anesthesia. Patients recruited were divided into two equal groups of 20 each. Group B received intraperitoneal nebulization with 4 ml of 0.75% ropivacaine and Group C received intraperitoneal nebulization with 4ml of saline before surgical dissection. Postoperative pain score using a numeric rating scale was monitored until 24 h, the need for rescue analgesics and associated complications were noted. Chi-square test, Student's test, and Mann-Whitney U test were used for statistical analysis. RESULTS: The pain score was significantly less in Group B during rest and deep breathing up to 24 h with a P value <0.05. The pain score on movement was also less in Group B and this difference was statistically significant at 6 and 24 h (P = 0.004 and 0.005, respectively). Tramadol consumption was less in Group B and was statistically significant at 24 h with P value of 0.044. No adverse events were noted. CONCLUSION: Intraperitoneal nebulization of ropivacaine is effective and safe in providing postoperative analgesia in patients undergoing laparoscopic cholecystectomy.
ABSTRACT
PURPOSE: To assess the safety and feasibility of laparoscopic donor nephrectomy with transvaginal extraction and impact of body mass index (BMI), menopausal status, previous surgery, and uterine fibroids. PATIENTS AND METHODS: Five-port conventional laparoscopic donor nephrectomy with successful transvaginal extraction of the kidney was performed in 30 donors. The parameters assessed included age, BMI, operative time, estimated blood loss, warm ischemia time, postoperative pain score, preoperative and postoperative sexual function, wound complications, hospital stay, return to normal activities, recipient creatinine level, and other recipient-related complications. The data were compared with 30 female donors who had laparoscopic donor nephrectomy and transabdominal extraction. RESULTS: The total number of patients who consented for the study was 38. In seven patients, an intraoperative decision to abort the transvaginal extraction was made because of obesity, pelvic adhesions, large uterine fibroids, and uterine artery injury. When compared with transabdominal extraction, there was no significant difference in warm ischemia time, mean operative time, estimated blood loss, hospital stay, recipient creatinine level, and complications. The mean pain score was significantly less on postoperative day 3 and day 4. There was also an earlier return to normal activities in the transvaginal group. There was no increase in infectious complication in both donors and recipient. CONCLUSION: Based on our initial experience with laparoscopic donor nephrectomy with transvaginal extraction, we recommend this procedure for a premenopausal donor, with a BMI <30. Our initial cases demonstrate that transvaginal extraction is feasible and safe for the donors.
Subject(s)
Kidney Transplantation/methods , Laparoscopy/methods , Living Donors , Natural Orifice Endoscopic Surgery/methods , Nephrectomy/methods , Tissue and Organ Harvesting/methods , Adult , Female , Follow-Up Studies , Humans , Middle AgedABSTRACT
Recombinant factor VIIa is a novel haemostatic agent and was originally developed to treat haemophilia patients. Successful use of the factor in a 30-year-old male patient with pelvic fracture haemorrhage is being described by the authors.
Subject(s)
Factor VII/therapeutic use , Fractures, Bone/complications , Hemorrhage/drug therapy , Pelvic Bones/injuries , Adult , Factor VIIa , Hemorrhage/etiology , Humans , Male , Recombinant Proteins/therapeutic useABSTRACT
Bilateral high amputation of upper limbs in a child is a very unusual injury. In the present case, although the amputation was high and significant avulsion was present, the age of the child (6 years) made the case both challenging and encouraging--challenging because of the anticipated systemic effects of reperfusion, and encouraging because the long-term prognosis is always more encouraging in a child.
