Effect of drainage on postoperative nausea, vomiting, and pain after laparoscopic cholecystectomy.

BACKGROUND: Laparoscopic cholecystectomy is associated with a high incidence of postoperative pain, nausea, and vomiting. Pneumoperitoneum created during the operation and residual gas after the operation are two of the factors in postoperative pain and nausea. We studied the effects of a subdiaphragmatic gas drain, which is intended to decrease the residual gas, on postoperative pain, nausea, and vomiting after laparoscopic cholecystectomy. PATIENTS AND METHODS: Seventy patients were randomized into two demographically and clinically comparable groups: drainage and control. Postoperative pain, nausea, and vomiting were measured by verbal grading and visual analog scale 2-72 h postoperatively. Analgesic and antiemetic use and incidence of retching, vomiting and other complaints were also recorded. RESULTS: Subdiaphragmatic drain effectively reduced the incidence and amount of subdiaphragmatic gas bubble. The incidence and severity of nausea was lower in the drainage group at 72 h. Although severity of pain was lower at 8 and 12 h in the drainage group, the difference was not significant. There was also no difference between the groups in regard to analgesic and antiemetic use. CONCLUSIONS: Subdiaphragmatic drain offers only minor, if any, benefit on postoperative pain, nausea, and vomiting after laparoscopic cholecystectomy, and this effect is probably clinically irrelevant.

Effect of neutralization of rat IL-6 bioactivity on collateral blood supply from retrograde flow via cortical anastomoses in the rat central nervous system.

The purpose of this study was to determine whether neutralization of rat interleukin-6 (IL-6) bioactivity increases the collateral blood supply from retrograde flow via the major middle cerebral artery branches after experimental middle cerebral artery occlusion in the rat. Seventy rats were randomly allocated to four main groups: Group I (n = 10) consisted of normal controls; Group II (n = 20) underwent craniectomy only; Group III (n = 20) was subjected to middle cerebral artery occlusion; and Group IV (n = 20) underwent middle cerebral artery occlusion and treatment with anti-rat IL-6 antibody. Half of the rats from each of Groups II, III and IV were killed at 24 h and the other half at 72 h after craniectomy alone or occlusion. A single dose of antibody did not affect middle cerebral artery caliber, but administration of three doses resulted in a significant increase in the diameter of middle cerebral artery compared to the findings in the corresponding occlusion-only groups. The results suggest that neutralization of rat IL-6 bioactivity in long-term recovery increases the collateral blood supply from retrograde flow via cortical anastomoses after experimental arterial occlusion in the rat brain.