Analgesia In Laparoscopic Cholecystectomy Research Articles

Effect of Perioperative Intravenous Lignocaine Infusion on Haemodynamic Responses and postoperative Analgesia in Laparoscopic Cholecystectomy Surgeries.

BackgroundDuring general anaesthesia, intubation of trachea and extubation of trachea are often associated with increase in haemodynamic response. Laparoscopic cholecystectomy is a minimal access surgery; postoperatively patients may experience moderate to severe pain. It is well known that lignocaine is useful in attenuating haemodynamic response to intubation and extubation. Previous studies also state that perioperative lignocaine infusion provides postoperative analgesia as well. We hypothesize that perioperative intravenous lignocaine infusion can both attenuate haemodynamic responses to intubation and extubation of trachea and also provide good postoperative analgesia in laparoscopic cholecystectomy surgeries.MethodsDouble blinded randomized controlled trial was undertaken at the department of anesthesia, Sri Siddartha medical college. In group A, 0.9% normal saline was used as placebo for perioperative intravenous infusion. In group B, preservative free 1.5 mg/kg 2 % lignocaine (Loxicard) diluted with normal saline to 1% given at 10 minutes to induction as bolus, followed by an infusion of 1.5 mg/kg/h. till 1 hour postoperatively.ResultsIn Group B there was a statistically less rise in heart rate [HR] and mean blood pressure [MBP] during intubation and extubation of trachea compared to group A. In group B there was a statistically significant increase in the mean pain free period postoperatively compared to group A.ConclusionsPerioperative intravenous infusion of lignocaine attenuates haemodynamic response during the intubation and extubation of the trachea. In addition, it also increases the mean pain free period postoperatively.

Management of a centenarian who underwent emergency laparoscopic cholecystectomy under general anesthesia with subcostal transversus abdominis plane block.

The anesthetic management of centenarians is challenging, since they have loss of functional reserve in all organs. The mortality rate of 25 % is reported in patients over 100 years old who underwent emergency surgery. The transversus abdominis plane block has been shown to provide effective analgesia in laparoscopic cholecystectomy. A 101-year-old woman was diagnosed with grade I (mild) acute cholecystitis with gallstones. An emergency laparoscopic cholecystectomy was scheduled. The patient had a history of hypertension. The patient’s laboratory data showed that she had mild coagulopathy, anemia, thrombocytopenia, and decreased renal function. After induction of general anesthesia, an ultrasound-guided, bilateral subcostal transversus abdominis plane block was performed. Her postoperative course was uneventful. Using the preoperative subcostal transversus abdominis plane block, we were able to avoid hemodynamic instability and to reduce opioid dosage in a centenarian who underwent emergency laparoscopic cholecystectomy under general anesthesia.

Comparative clinical study of gabapentin and pregabalin for postoperative analgesia in laparoscopic cholecystectomy.

Background:Reduction in central sensitization by gabapentinoids that include gabapentin and pregabalin may reduce acute postoperative pain.Aims:The aim of this study is to evaluate postoperative analgesic benefit and efficacy in patients administered with oral gabapentin or pregabalin as premedication for laparoscopic cholecystectomy under general anesthesia.Settings and Design:Randomized, prospective, and comparative study.Materials and Methods:In this study, recruited patients were randomly allocated in three groups. Groups A, B, and C received 2 capsules of B complex, 3 capsules of 300 mg gabapentin each, and 2 capsules of 75 mg pregabalin, respectively, each in 30 patients of each group, 1 h before induction of anesthesia. Postoperative efficacy among these three groups was compared with respect to increase in duration of analgesia, reduction in postoperative pain scores, total postoperative requirements of analgesics and side effects.Statistical Analysis:Mean and standard deviation were calculated. Test of analysis between two groups was done by t-test and among three groups by analysis of variance, and then P value was calculated.Results:Pregabalin and gabapentin group had lower visual analog scale (VAS) score (P < 0.05), prolonged timing of first rescue analgesic (4.67 ± 14.79 vs. 158 ± 13.10 vs. 343.16 ± 9.69) min, and less opioid consumption (169.87 ± 20.32 vs. 116.13 ± 14.08 vs. 64.67 ± 16.69) mg compared to placebo group. Between the gabapentinoids, pregabalin group had lower VAS score, prolonged timing of first rescue analgesic, and less opioids consumption than the gabapentin group.Conclusion:It is concluded in this study that pregabalin group had lower VAS score, prolonged timing of first rescue analgesic, and less opioids consumption than the gabapentin group. Both gabapentinoids had better postoperative analgesic profile than placebo.

Comparative evaluation of efficacy of intravenous paracetamol and intravenous diclofenac as post-operative analgesia in laparoscopic cholecystectomy

Background: Though laparoscopic cholecystectomy is a minimal invasive surgery but inadequate pain management interferes with early discharge of patient. Administration of opioid for pain relief is a concern because of its side effects. To avoid this problem, we planned our study to find out the best alternative of opioid in patients undergoing laparoscopic cholecystectomy. Methods: 68 patients were enrolled for this study in a stipulated time of 1 year in a tertiary level hospital. A questionnaire was responded by patients and a chart was maintained for pain score in visual analogue scale (VAS) and for side effects. We used paracetamol and diclofenac as post operative analgesic in two different groups and data was recorded in Excel panel and was analyzed by standard statistical test by software MINITAB 1513 with a significant p- value of <0.05. Results: We have found the significant outcome (p-values are 0.0005 at 0 hrs, 0.003 at 2 hrs, 0.001 at 6 hrs, 0.0005 at 12 hrs) in VAS pain score in between the two groups at different intervals. Patients who were administered paracetamol had shown better outcome with less requirement of rescue analgesia and side effects. Conclusion: Administration of intravenous paracetamol in the intra operative period 30 minutes prior to the completion of surgery followed by administration of 1g paracetamol every 8 hourly in the post-operative period gives better quality of analgesia.

Comparison of Posterior and Subcostal Approaches to Ultrasound-Guided Transversus Abdominis Plane Block for Postoperative Analgesia in Laparoscopic Cholecystectomy

*Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh; and †Department of Anaesthesia, Fortis Hospital, Punjab, India.

Comparison of posterior and subcostal approaches to ultrasound-guided transverse abdominis plane block for postoperative analgesia in laparoscopic cholecystectomy

Study ObjectiveTo evaluate the effectiveness of subcostal TAP block and to compare its efficacy with that of posterior TAP block in decreasing postoperative pain in patients undergoing laparoscopic cholecystectomy during general anesthesia. DesignProspective, randomized, double-blind study. SettingAcademic medical center. Patients60 adult, ASA physical status 1 and 2 patients of both genders, aged 18-60 years, scheduled for elective laparoscopic cholecystectomy. InterventionsPatients were randomized to three groups of 20 patients each. Group 1 patients received standard general anesthesia (control group); Group 2 patients received an ultrasound-guided posterior TAP block using 15 mL of 0.375% ropivacaine on each side; and Group 3 patients underwent a subcostal TAP block with 15 mL of 0.375% ropivacaine on each side. MeasurementsThe presence and severity of pain during rest and movement, as well as nausea or vomiting and sedation, were assessed in all patients postoperatively on PACU admission, then at 2, 4, 6, 8, 12, and 24-hour intervals. Patients with a visual analog score (VAS) greater than 4, or those requesting analgesic were given intravenous tramadol 2 mg/kg as an initial dose; subsequent 1 mg/kg doses of tramadol, if needed, were given. ResultsPatients who received a subcostal TAP block had significantly lower pain scores at rest and on movement than the control group at all times postoperatively. Although, in the initial postoperative measurement times, the subcostal and posterior TAP groups had comparable pain scores, after 4 hours these scores were significantly lower in patients who had received the subcostal TAP block. ConclusionFor incisions mainly involving the supra-umbilical region, subcostal TAP block may be a better alternative than the posterior approach for providing postoperative analgesia.

Comparison postoperative analgesia between fentanyl and tramadol in laparoscopic cholecystectomy

Objective To observe the effects of intravenous injection of fentanyl and tramadol on postoperative analgesia in laparoscopic cholecystectomy of clinical efficacy.Methods 80 cases treated with laparoscopic cholecystectomy were randomly divided into the fentanyl group (group F) and tramadol group (group Q).VAS score,adverse reaction incidence and patient satisfaction,were observed after the administration of 0.5,1,2,4,8,12h.Results In group F after administration of 0.5,1,2h,VAS score was better than that of group Q; group F after administration of the drug 4,8 h VAS score was inferior to group Q;two groups of patients in postoperative 12h VAS scores showed no significant difference in group F;the overall incidence of adverse reactions was higher than that of group Q,patients' satisfaction was higher than that of group Q.Conclusion Intravenous fentanyl in laparoscopic cholecystectomy operation postoperative overall are superior to the analgesic effect of tramadol,with high patient's satisfaction. Key words: Analgesia; Cholecystectomy, laparoscopic ; Fentanyl; Tramadol

Ultrasound-guided transversus abdominis plane blocks for analgesia post cesarean section

Correspondence: Sara MC Kelly Department of Anesthetics, Russell’s Hall Hospital, Pensnett Rd, Dudley, west Midlands, DYi2HQ, UK Tel +44 1384244076 Email sarakelly7@hotmail.com Introduction: Cesarean section is a commonly performed operation and postoperative analgesia is needed so the mother can bond and look after her newborn. Transversus abdominis plane (TAP) blocks have been shown to improve postoperative analgesia in laparoscopic cholecystectomy and hysterectomies. The purpose of this article is to review the evidence for the use of TAP blocks in cesarean sections. Methods: A literature search identified four randomized controlled trials that looked at the use of TAP blocks in cesarean section. Copies were obtained and critically appraised. Results: Four randomized controlled trials were found that looked at the use of TAP blocks in cesarean sections. Two studies showed that TAP blocks reduced the postoperative analgesic requirements of patients compared to a placebo; one paper showed no difference when TAP blocks were used. In a study comparing TAP blocks with subarachnoid morphine, TAP blocks were associated with poorer postoperative pain scores and higher rescue analgesia. There was no consistent local anesthetic dose used amongst the trials. None of the studies revealed any statistically significant side effects from TAP blocks. Discussion: TAP blocks have been shown to offer improved pain relief after cesarean sections when compared to a placebo, but have been shown to be inferior to subarachnoid morphine. Standardization of local anesthetic and dosage may result in an improved evidence base from which to draw clinically relevant conclusions.

Effects of preemptive analgesia in laparoscopic cholecystectomy: a double-blind randomized controlled trial

This study aimed to investigate the effect of preemptive etoricoxib compared with placebo in laparoscopic cholecystectomy. This randomized, double-blind, placebo-controlled study enrolled 120 patients requiring elective laparoscopic cholecystectomy. The patients were randomized to receive either etoricoxib 120 mg plus diazepam or placebo plus diazepam. Postoperatively, the visual analog score (VAS) for pain, the rescue morphine requirement, and the side effects were recorded. Between February 2006 and September 2007, 120 patients were enrolled in the study. The demographic data between two groups were similar except for mean age. The mean age of the placebo group was younger (p = 0.007). There were no significant differences in bleeding tendency rating scores, duration times between fentanyl and rescue morphine, number of rescue morphine doses, or length of postoperative hospital stay. But the number of oral analgesic drug usages was significantly less in the etoricoxib group (p = 0.006). The postoperative VAS was lower in the etoricoxib group at hours 10 (p = 0.023), 14 (p = 0.045), and 26 (p = 0.011), and the average VAS also was significantly less in the etoricoxib group (p = 0.013). The two groups did not differ significantly in terms of postoperative shoulder pain (p = 0.065). According to the verbal rating scale, the incidence of postoperative nausea and vomiting did not differ significantly between the two groups (p = 0.797), nor did the drug side effects or treatment complications. The authors recommend using etoricoxib as a preemptive analgesia to reduce postoperative pain after laparoscopic cholecystectomy.

Celecoxib premedication in post-operative analgesia for laparoscopic cholecystectomy

Abstract The analgesic effect of celecoxib on postoperative laparoscopic cholecystectomy pain was studied in a prospective, randomized, placebo-controlled, double-blind study. Sixty ASA 1 and 2 patients were randomized to receive celecoxib 200 mg or placebo orally before the operation under a standardised general anaesthetic for the elective surgery. All patients had intravenous morphine via a patient-controlled analgesia device (PCA). Postoperative abdominal and trochar site pain, shoulder pain and morphine consumption were assessed hourly until the 6th hour, and then at the 12th and 24th hour. There was no statistical significance in the pain scores and morphine consumption for the two treatment groups. We conclude that the opioid-sparing effect of celecoxib in acute pain management for laparoscopic cholecystectomy is clinically not useful and a combination of analgesia techniques may be more effective in treatment of multi-factorial post laparoscopic cholecystectomy pain.