Effectiveness of Intraperitoneal Bupivacaine in Reducing Postoperative Morphine Used among Total Abdominal Hysterectomy Patients at Phramongkutklao Hospital.

Objective: To study the effectiveness of intraperitoneal bupivacaine in reducing 24-hour postoperative morphine used in women underwent total abdominal hysterectomy. Material and Method: Sixty-two non-malignant gynecologic patients, aged 25 to 65 years, ASA class I-II, underwent elective total abdominal hysterectomy. On the operative day, patients were allocated simple random sampling. Blinded intraperitoneal solution was prepared and numbered for each patient. In total, 40 ml of 0.25% bupivacaine solution or normal saline was applied in the pelvic cavity after completed the operation. The abdominal muscle and subcutaneous fat were infiltrated with 0.25% bupivacaine 10 ml each layer. Intravenous morphine patient-controlled analgesia (PCA) was started in the recovery room. The assessment of total morphine used, sedative score, numerical rating score (NRS) for pain, postoperative nausea vomiting (PONV), pruritus, and the number of vomiting and antiemetic drugs used were recorded at 1, 2, 4, 8, 12, and 24 hours after intraperitoneal administration. Patients' satisfactory NRS was evaluated after PCA cessation. Repeated measure ANOVA was used to compare means between two groups. Baseline characteristics were calculated by descriptive statistics, i.e., mean, standard deviation, median, and range. A p-value less than 0.05 was considered statistically significant. Statistical package for the social sciences (SPSS) for Windows version 23 was used. Results: There were no significant differences were found between the two groups in general patients' characteristics, intraoperative data, and anesthetic administration. Total morphine consumption at 24 hours after intraperitoneal administration was significantly less in the bupivacaine group than the saline group (25.03 vs. 16.13, p = 0.002). Lower pain score at 1 and 2 hours and significant difference in reduced morphine consumption were observed within the first 4 hours after intraperitoneal bupivacaine administration. Postoperative 24 hours satisfactory score, PONV, pruritic score, overall incidences of vomiting and antiemetic use were similar in both groups. Sedative scores were lower in the bupivacaine group except at 1 and 24 hours postintraperitoneal administration. No evidence of local anesthetic toxicity or operative complication was identified. Conclusion: Administration of intraperitoneal and incisional 0.25% bupivacaine at the completion of total abdominal hysterectomy produced a significant reduction in 24-hour postoperative morphine used without adverse effect.

Human papillomavirus infection following radiation therapy or concurrent chemoradiation for invasive cervical cancer.

OBJECTIVE: To determine the prevalence of Human Papillomavirus (HPV) infection in patients with invasive cervical cancer after treatment by concurrent chemoradiation therapy. MATERIAL AND METHOD: Cervicovaginal mucous samples were collected from fifty-five patients with invasive cervical cancer two months after treatment completion and tested for HPV genotypes. RESULTS: Of the 55 patients, 31 (56.36%) were found to be positive for HPV among these 25 (45.46%) were positive for high-risk HPV. The most common high-risk HPV found was type 16 which accounted for 35.48% (11/31) of cases. Other high-risk HPV found were types 18 (16.13%), 52 (16.13%) and 58 (12.90%). Follow-up time for patients were 3 to 22 months with mean follow-up of 13 months. In patients positive for high-risk HPV 24.00% (6/25) were found to have persistent or recurrent disease. While 30 patients negative for high-risk HPV 3.33% (1/30) were found to have persistent or recurrent disease. CONCLUSION: The prevalence of HPV infection in cervical cancer patients with positive high-risk HPV after treatment by radiation or concurrent chemoradiation seems to be a risk factor for persistent and recurrent disease. Testing for high-risk HPV may be a useful modality for follow-up of these patients.

Effectiveness of paracervical block versus intravenous morphine during uterine curettage: a randomized controlled trial.

BACKGROUND: Abnormal uterine bleeding is a common gynecologic problem. Fractional curettage, evacuation and curettage, and dilatation curettage are common gynecologic procedures for investigation and treatment of abnormal uterine bleeding. To perform all these procedures, anesthesia is needed but technique varies among hospitals. The standard procedure of uterine curettage was performed after paracervical block or intravenous morphine injection. OBJECTIVE: To compare pain scores during and after uterine curettage using intravenous morphine versus paracervical block MATERIAL AND METHOD: A randomized controlled trial study was performed. Sixty-four patients with abnormal uterine bleeding and indication for curettage were enrolled in the present study. Simple randomized procedure was used to distribute the patients into two groups. Intravenous morphine was carried out in 32 patients as the group A while paracervical block was used in the other 32 patients of the group B before uterine curettage. The main outcome measurement was pain score, which assessed by Numerical rating scale ranging from 0-10. RESULTS: The median pain score during uterine curettage were 7.5 and 6 (p = 0.103), immediately after uterine curettage were 3 and 3 (p = 0.822) and 30 minutes after uterine curettage were 1 and 1 (p = 0.206) in the control and treatment group, respectively. CONCLUSION: Pain scores in patients who received paracervical block were not statistically different from those who received intravenous morphine. Paracervical block could be used as another choice for pain relief during uterine curettage.

Gemcitabine and radiotherapy in the treatment of uterine cervical cancer patients at Phramongkutklao Hospital.

OBJECTIVES: To determine response, complication and survival of uterine cervical cancer patients treated with concurrent gemcitabine radiotherapy. MATERIAL AND METHOD: A retrospective review of medical records of 41 patients with uterine cervical cancer patients, stage IIB and above treated with concurrent gemcitabine radiotherapy from August 2000 to August 2003. RESULTS: At 6 and 12 months of follow up, the complete response rate was 75.6% and 65.9%. The cumulative probability of survival at 6 and 12 months after treatment was 0.93 and 0.85. The main complications were mild hematologic and nonhematologic toxicities. CONCLUSION: Concurrent gemcitabine radiotherapy provided a satisfactory response in patients with uterine cervical cancer with mild toxicity. Long term follow up data is necessary to determine the recurrent rate of this regimen.