Analgesia In Laparoscopic Cholecystectomy Research Articles

Comparative Evaluation of Effectiveness of Intravenous Paracetamol and Intravenous Diclofenac as Post-operative Analgesia in Laparoscopic Cholecystectomy

Introduction: Though the development of minimally invasive surgery has revolutionized the field of surgery, post-operative pain is still a significant issue. Unlike in the past, concerns about adverse effects have limited the role of opioids in post-operative pain management. This study aims to compare the effectiveness of intravenous paracetamol and diclofenac as postoperative analgesia in laparoscopic cholecystectomy.
 Methods:One hundred and twenty eight patients of American Society of Anesthesiologists (ASA) categories I and II included in this study were divided into two groups. Anesthesia induction and maintenance were standardized. The first group received 15mg/kg (maximum 1gm) intravenous paracetamol and the second group received 2mg/kg (maximum 75mg) intravenous diclofenac 30 minutes prior to ending of surgery. A questionnaire was responded by patients and chart was maintained by visual analogue scale. Mann Whitney U test was used to analyze quantitative data and Chi-square test for categorical data. P value <0.05 was considered statistically significant.
 Results: Profiles of hemodynamic changes were almost similar in both groups with respect to heart rate and blood pressure. However, paracetamol infusion provided hemodynamic stability in post-operative period. We observed statistically significant differences in visual analogue scale between the two groups. Most of the patients in paracetamol group had low mean pain scores in post-operative period and provided an extended analgesia compared to diclofenac. No serious postoperative complication was observed in paracetamol group.
 
 Conclusion: Administration of intravenous paracetamol has better and prolonged analgesic effect with low mean pain score and less requirement for rescue analgesia compared to diclofenac.

Effect of Intraperitoneal Ketamine as Postoperative Analgesia in Laparoscopic Cholecystectomy

Background: Laparoscopic surgery is gaining popularity so different modalities of pain management should be used as patients experience postoperative pain of different sources especially from the abdomen, back and shoulder region which is severe especially in first postoperative hours. Objective: We aimed to evaluate effect of intraperitoneal instillation of ketamine and normal saline on post- operative pain and analgesic requirements after laparoscopic cholecystectomy. Patients and Methods: Forty patients undergoing laparoscopic cholecystectomy were randomly allocated and divided into two groups, The ketamine intraperitoneal (KIP) group (n=20 patients), in which 0.5 mg/kg ketamine diluted in 30 ml normal saline was instilled intraperitoneally,The saline intraperitoneal (SIP) group (n=20 patients), in which 30 ml of normal saline was instilled intraperitoneally. Patients receive these drugs as follow, 16 ml in gall bladder fossa while other 14 ml under copula of diaphragm on both sides while patients were placed in 15-20-degree trendelenburg position. This was done before patients recovered from anesthesia, then patients extubated and transferred to ward. Patients were evaluated according to VAS, time to first analgesic and total analgesic requirements during 24 hours post-operative. Results: Our results showed that usage of ketamine decreases postoperative pain and analgesic consumption in the first 24 hours after surgery along with longer pain free period compared to patients who were given bupivacaine after laparoscopic cholecystectomy. In our study ketamine 0.5mg/kg was safely used as we did not observe any sign of toxicity. Conclusion: Intraperitoneal instillation of local anesthetic is an easy, cheap and safe method which provides good analgesia in the immediate postoperative period after laparoscopic surgery. Ketamine is highly effective in postoperative pain control in laparoscopic cholecystectomy without any hazards on patients.

Evaluation of ultrasound-guided erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: A prospective, randomized, controlled clinical trial

Study objectiveLaparoscopic cholecystectomy (LC) is a commonly performed minimally invasive procedure that has led to a decrease in procedure-related mortality and morbidity. However, LC requires analgesia that blocks both visceral and somatic nerve fibers. In this study, we evaluated the effectiveness of Erector Spinae Plane Block (ESPB) for postoperative analgesia management in LC. DesignSingle-blinded, prospective, randomized, efficiency study. SettingTertiary university hospital, postoperative recovery room & ward. Patients36 patients (ASA I-II) were recruited in two equal groups (block and control group). Following exclusion, 30 patients were included in final analysis. InterventionsStandard multimodal analgesia was performed in Group C (control) while ESPB block was also performed in Group B (block). MeasurementsPain intensity between groups were compared using Numeric Rating Scores (NRS). Also, tramadol consumption and additional rescue analgesic requirement were measured. Main resultsNRS was lower in Group B during the first 3 h. There was no difference in NRS scores at other hours. Tramadol consumption was lower in Group B during the first 12 h. Less rescue analgesia was required in Group. ConclusionBilateral ultrasound guided ESPB leads to effective analgesia and a decrease in analgesia requirement in first 12 h in patients undergoing LC.

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

AbstractBackground: Pain after LC is complex and characterized by various components with different intensities and time courses. The establishment of LC as an outpatient procedure has accentuated the clinical importance of proper post-operative pain control.Aim: Our aim is to compare between US posterior and subcostal approaches TAP block for post-operative analgesia in LC.Material and Methods: This study was carried out on 60 patients, ASA I-II, scheduled for elective laproscopic chole-cystectomy under general anesthesia. Patients were randomized into three equal groups (20 patients in each group): Group I (control group): Received standard general anesthesia. GroupII (posterior TAP group): Received standard general anesthesia and bilateral US guided posterior TAP block with 15ml bupivacaine 0.25% on each side just before extubation. GroupIII (subcostal TAP group): Received standard general anesthesia and bilateral US guided subcostal TAP block with 15ml bupivacaine 0.25% on each side just before extubation. All groups received post-operative analgesia in the form of IV paracetamol 1gm every 6 hours and rescue analgesic in form of morphine 2mg IV. The following parameters were compared: Post-operative vital signs (HR & MAP), post-operative pain (using 10 point Visual Analogue Scale (VAS) where (0) no pain and (10) most intense pain), time for first post-operative required analgesia and 24-hour morphine consumption were measured in the 3 groups immediately after full recovery of anesthesia, 1h, 2h, 4h, 6h, 8h, 12hr & 24hr.Results: In our study the mean values of HR and MAP were lower in Group II and Group III than Group I & that of Group III were lower than that of Group II at all times after recovery. The mean values of pain assessment by VAS in Group II and Group III were lower than that of Group I at all times after recovery. The VAS in Group III were lower than that of Group II insignificantly immediately after recovery, 1h, 2h, 12h and 24 hours and significantly at 4h, 6h and 8 hours. Also the mean time to the first request of morphine, was longer in Groups II and III than in Group I. Group III was significantly longer than Group II. The total dose of post-operative morphine consumption in Group II and Group III were lower than that in Group I. There was significantly lower total dose of post-operative morphine consumption in Group III than Group II.Conclusion: Both the posterior and subcostal US TAP block provides superior analgesia than the standard IV regimen. However, beyond the initial 4 hours after recovery, patients in the subcostal TAP group had significantly lower pain scores than did patients from the other groups.

Effect of Dexmedetomidine on Intraoperative Haemodynamics and Postoperative Analgesia in Laparoscopic Cholecystectomy

Background and objectives:Dexmedetomidine is an α2 agonist with sympatholytic, anxiolytic, sedative and analgesic effect used as adjunct during surgeries for its haemodynamic stabilizing effect and analgesic effect. Primary aims of the study were to evaluate the haemodynamic effect of intravenous dexmedetomidine and the duration and quality of analgesia in laparoscopic cholecystectomy. Secondary aims were sedation levels and occurrence of side effects.Materials and methods:Eighty four patients, American society of Anaesthesiologists physical status I and II, aged 18-60 years of either gender undergoing laparoscopic cholecystectomy in general anaesthesia were randomly allocated into two equal groups. Group C patient received Normal Saline and Group S patient received dexmedetomidine loading dose infusion of 1µg/kg over 10 minutes before induction and maintained with 0.4µg/kg/hr till the removal of gall bladder. Induction with propofol and fentanyl was done. Standard monitoring including Heart Rate, Mean arterial pressure, oxygen saturation were monitored perioperatively. Postoperative analgesia requirement and sedation score were assessed.Results: In Group S, the haemodynamic responses were significantly attenuated. During postoperative period, 24 hours analgesic requirement of diclofenac sodium was 141.43mg in group S as compared to 217.50mg in group C(p<0.001). Side effects were treatable. Sedation was better in Group S.Conclusion:Dexmedetomidine effectively attenuates haemodynamic stress response during laparoscopic surgery with reduction in postoperative analgesic requirements.

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.