A comparative study of the analgesia requirements following laparoscopic and open fundoplication in children.

To introduce a new procedure, careful evaluation of its effects must be undertaken to assess its impact. Laparoscopic procedures in children are a relatively new phenomenon. A reduction in analgesia is a frequently quoted benefit of a laparoscopic procedure. The introduction of laparoscopic fundoplication into our surgical armoury lead us to evaluate the analgesia requirements of a laparoscopic procedure compared to conventional surgery. Comparative analysis of the analgesia requirements of 40 fundoplication procedures (20 laparoscopic, 20 open) was undertaken. All the pain-relief data was prospectively documented by a pain team as part of an ongoing hospital audit. This pain team was unaware of the comparative study, but were assessing the quality of analgesia within the hospital trust. The total amount of morphine analgesia required was similar for both laparoscopic and open surgery (0.432+/-0.28, 0.427+/-0.28 mg/kg). The period for which analgesia was required was significantly less in the laparoscopic group (1.2+/-0.46, 2.7+/-0.67 days; p = 0.03), yet the requirement for morphine during the first 24 hours was greater in the laparoscopic group (0.399+/-0.19, 0.22+0.11 mg/kg, p = 0.02) despite similar NSAID requirements (18+/-17.28, 18+/-20.16 mg/kg, respectively). The benefit of a laparoscopic over an open fundoplication would appear to be in the decreased duration of pain, as indicated by the decreased duration of analgesia following surgery.

The effect of isoflurane or spinal anesthesia on indocyanine green disappearance rate in the elderly.

This study was designed to measure the disappearance rate of indocyanine green (ICG) as an indicator of hepatic blood flow in elderly patients undergoing internal fixation of fractured neck of femur. All patients were aged 60-90 yr and were randomized to receive either spinal (n = 10) or isoflurane (n = 10) anesthesia. In both groups systolic arterial blood pressure was maintained within 15% of resting levels by administration of fluids intravenously without vasoactive drugs. Patients were excluded if they required vasopressors to maintain arterial blood pressure. ICG disappearance rate was calculated using a single bolus technique before induction of anesthesia, and at 30, 60, and 120 min after induction of anesthesia. Sixteen patients completed the study. There were no statistically significant changes in ICG disappearance rate in either group at any time during the study, indicating that hepatic blood flow is not significantly altered by either spinal or isoflurane anesthesia provided that arterial blood pressure is maintained.