Elective Abdominal Hysterectomy Research Articles

Evaluation of lignocaine, dexmedetomidine, lignocaine-dexmedetomidine infusion on pain and quality of recovery for robotic abdominal hysterectomy: a prospective randomized controlled trial

Background: Acute postoperative pain is associated with poor quality of recovery after surgery. Perioperative use of intravenous lignocaine or dexmedetomidine have demonstrated better pain control, early return of bowel function, and effects on quality of recovery.Methods: Ninety-six women planned for elective robotic abdominal hysterectomy were randomized into four groups. Groups received lignocaine infusion (1.5 mg.kg−1 loading, 2 mg.kg−1.h−1 infusion) (Group I), dexmedetomidine infusion (1 µg.kg−1 loading, 0.6 µg.kg−1.h−1 infusion) (Group 2), lidocaine (1.5 mg.kg−1 loading, 2 mg.kg−1.h−1 infusion), and dexmedetomidine infusions (1 µg.kg−1 loading, 0.5 µg.kg−1.h−1 infusion) (Group 3), and normal saline 10 mL loading, 1 mL.kg−1.h−1 infusion) (Group 4). Primary outcome was visual analogue pain scores at 1, 2, 4, 12, and 24 hours after surgery. Secondary outcomes included postoperative fentanyl requirement, time of return of bowel sounds and flatus, QoR15 score on day 1, 2, and discharge.Results: The VAS was significantly lower in Groups 2 and 3 compared to Groups 1 and 4. Total postoperative fentanyl consumption in the first 24 hours was 256.25 ± 16.36 mcg (Group 1), 177.71 ± 16.81 mcg (Group 2), 114.17 ± 16.19 mcg (Group 3), and 304.42 ± 31.26 mcg (Group 4), respectively. Time to return of bowel sounds and passage of flatus was significantly shorter in Groups 2 and 3 (p < 0.01). QoR15 scores after surgery were higher in Group 3 compared to Groups 1, 2, and 4, (p < 0.01) respectively.Conclusion: Combined infusion of lignocaine and dexmedetomidine significantly decreased postoperative pain, fentanyl consumption, and improved quality of recovery score after surgery in patients undergoing Robotic abdominal hysterectomy.

Complete Molar Pregnancy in Postmenopausal Woman: A Rare Case Report

BACKGROUND: Molar pregnancy, the form of the gestational trophoblastic disease (GTD), generally occurs in women of the reproductive age group, and rarely occurs in postmenopausal women. To present a rare case of molar pregnancy in a postmenopausal woman. CASE REPORT: A multiparous woman aged 54 years was referred to the outpatient department at Raja Ahmad Tabib General Hospital of Riau Island, Indonesia with the main symptoms of nausea and vomiting profusely with 1 month before, lower abdominal pain, lump in the abdomen, abnormal vaginal bleeding, and a positive urine pregnancy test. Her last menstrual bleeding was 14 months ago. Physical examination found stable hemodynamic within blood pressure 150/95 mmHg. Laboratory results showed Hb 11.7 g/dL, positive urine pregnancy test, and serum β-HCG 292,876.1 mIU/mL. Ultrasound examination showed a vesicular pattern in the uterine cavity without fetal tissue. The patient was managed by elective total abdominal bilateral hysterectomy salpingo-oophorectomy. The intraoperative finding was softened, enlarged uterus size of 14–16 weeks of pregnancy, and no local spreading of disease. The patient was discharged on the 3 day after surgery. CONCLUSION: Even though molar pregnancy is rare, it can occur in the postmenopausal woman. Therefore, GTD has remained in the differential diagnosis of postmenopausal bleeding which can prevent delay in diagnosis and management. Definitive treatment with total abdominal hysterectomy has been chosen in menopausal women who do not wish to preserve their fertility and prevent any malignant sequelae.

A COMPARATIVE STUDY OF 0.5 % BUPIVACAINE WITH FENTANYL VERSUS 0.75% ROPIVACAINE WITH FENTANYL IN EPIDURALANESTHESIA FOR ABDOMINAL HYSTERECTOMY

INTRODUCTION Abdominal hysterectomy (AH) is a quite common gynaecological surgical procedure and electively done under central neuraxial blockade. AH is performed for malignant as well as benign indications such as uterine leiomyoma, persistent vaginal bleeding, or pelvic organ prolapse. AIMS AND OBJECTIVES Compare the onset of motor and sensory block. Find out the duration of the sensory and motor blockade. Observe intraoperative hemodynamic changes and assess post-operative analgesia requirements in 24 hour. Duration of analgesia assessed by requirement of rst rescue analgesic. Observe any untoward incident during intraoperative and post-operative period and managed accordingly MATERIALS AND METHODS Study Area: Department of Anesthesiology &amp; critical care, DARBHANGAMEDICALCOLLEGE AND HOSPITAL. Study Population: Adult patients (30- 65 years) undergoing elective abdominal hysterectomy with regional anaesthesia were included for this study. Study Period:January 2019 to March 2020 Sample Design: Subjects were divided into two groups (n=35) equal in numbers and they sampled as per computerized randomization chart. These patients were divided into two groups, group B (with epidural 0.5% bupivacaine and 100g fentanyl) and group R (with epidural 0.75% ropivavaine and 100g fentanyl). Study Design: Prospective, open, randomized, controlled study. RESULTS: In Our study showed that 3.38kg/m2 and 24.86 3.60 kg/m2in group B and R respectively. The duration of surgery was 100.86 9.35minutes and 98.86 8.32 minutes and the duration of stay, was4.86 0.81days and 4.60 0.914 days in group B and group R respectively. Now with comparison of both groups, time to onset of sensory block (uptoT6) has signicant variation. But the other parameters namely, time to onset of motor block, two segment regression or duration of sensory block, rescue analgesia timing and complete motor recovery time were comparable and not signicant statistically in both groups. SUMMARY &amp; CONCLUSIONS To conclude that in the present study using 0.5% bupivacaine with fentanyl and 0.75% ropivacaine with fentanyl epidurally, ropivacaine produced an earlier onset but similar duration of sensory block. The onset, quality and duration of motor block werecomparable in both the groups. It is important that new local anaesthetics with lower cardiotoxic property are adopted to ensure that regional techniques using large amounts of local anaesthetics remain safe with minimal complications. The recovery prole of ropivacaine may be useful where prompt mobilization is require

Allopurinol attenuates postoperative pain and modulates the purinergic system in patients undergoing abdominal hysterectomy: a randomized controlled trial.

Allopurinol is a potent inhibitor of the enzyme xanthine oxidase used primarily in the treatment of hyperuricemia and gout. The aim of this study was to compare the analgesic efficacy of preanesthetic allopurinol versus placebo on postoperative pain and anxiety in patients undergoing abdominal hysterectomy. This is a prospective, double-blinded, placebo-controlled, randomized clinical trial. We investigated 54 patients scheduled to undergo elective abdominal hysterectomy. Patients were randomly assigned to receive either oral allopurinol 300mg (n = 27) or placebo (n = 27) the night before and 1h before surgery. Patients were submitted to evaluation of pain and anxiety before the treatment, for 24h postoperatively, 30 and 90days after surgery. Cerebrospinal fluid was collected at the time of the spinal anesthesia to perform the measurement of the central levels of purines. Preoperative administration of allopurinol was effective in reducing postoperative pain 2h after surgery. Allopurinol caused a reduction of approximately 40% in pain scores measured by the visual analogue pain scale after surgery (p < 0.05). No differences were found between groups in anxiety scores after surgery. There was a significant change in the cerebrospinal fluid concentrations of xanthine and uric acid before surgery (p < 0.01). This study showed a short-term benefit of the use of allopurinol as a preanesthetic medication since it was related to a reduction on pain scores 2h after surgery. The purinergic system is a potential target for new analgesic drugs. New studies investigating more selective purine derivatives in the management of pain should be performed. Brazilian Registry of Clinical Trials-ReBEC #RBR-9pw58p.

Comparative Study of Postoperative Pain Relief Using Preincisional Versus Postincisional Infiltration With 0.25% Bupivacaine in Abdominal Hysterectomy Under General Anesthesia

Background and Aims:Hysterectomy, probably the most common non-pregnancy related surgery performed in gynaecology, is associated with moderate to severe post-operative pain. Wound infiltration with local anaesthetic agent reduces the transmission of pain from the wound, in addition, local inflammatory response to the injury is also suppressed. The infiltration of local anaesthesia can be done either pre- or post-operatively. The present study was designed to determine the efficacy of pre-incisional infiltration versus post-incisional infiltration with 0.25% Bupivacaine in providing post-operative pain relief in patients undergoing abdominal hysterectomy.Methods:In Prospective Interventional Randomised study, 90 female patients posted for elective abdominal hysterectomy under general anaesthesia were randomly allocated into three equal groups of 30 patients each.Group I:Patients receiving subcutaneous infiltration with 40 mL of 0.25% Bupivacaine 5 mins before skin incision.Group II:Patients receiving subcutaneous infiltration of surgical area with 40 mL of 0.25% Bupivacaine at end of surgery (after peritoneal closure).Group III (Control Group):Patients receiving no local anaesthetic infiltration. Observations were made for the duration of effective analgesia from end of the surgery until the first use of rescue analgesic along with the frequency and cumulative amount of rescue analgesics in 24 hours.Results:We found that at baseline, pain score of patients in Group III (3.87±1.17) was maximum followed by that in Group I (2.57±0.90) and minimum in Group II (2.20±0.61). Requirement of first analgesia was earliest in Group III (79.50±23.90 minutes) followed by Group I (136.83±13.16 minutes) and last in Group II (146.17±12.78 minutes), in addition, cumulative dose of analgesia was required by patients in Group III (152.50±36.76 mg) followed by that in Group I (132.50±37.80 mg) and minimum by that in Group II (115.00±38.06 mg).Conclusion:Subcutaneous infiltration of Bupivacaine either pre-incisional or post-incisional, helped to reduce the immediate post-operative pain intensity, delayed the first rescue analgesic requirement, reduced the post-operative dose and frequency of rescue analgesia. However, post-incisional intervention had an edge over pre-incisional intervention.

Euglycemic Diabetic Ketacidosis in a Postoperative Patient with Type 2 Diabetes on Empagliflozin and Linagliptin

Introduction: EDKA is defined as a triad comprising high anion gap metabolic acidosis with positive serum and urine ketones when serum glycemic levels are <14mmol/L. EDKA is thought to be facilitated by factors such as partial treatment of DKA, food restriction, alcohol intake, and inhibition of gluconeogenesis Case Description: A 46- year-old lady with type 2 diabetes (T2DM) on Metformin, linagliptin and empagliflozin was admitted for an elective total abdominal hysterectomy with bilateral salpingo- oophorectomy for fibroids. On day 4 post-op, she complained of general malaise and thirst. She was apyrexial and her physical examination was unremarkable. Initial laboratory findings were significant for leucocytosis (13,500/μL), elevated C reactive protein (174), and metabolic acidosis with a bicarbonate of 6mmol/l, H ions 73 nmol/l and blood glucose of 13.9mmol/L. Urinalysis showed glycosuria and proteinuria. Based on these findings, she was diagnosed as euglycemic diabetic ketoacidosis (euDKA) with precipitating factor being surgery and reduced oral intake post procedure and started on insulin drip and intravenous fluids, with monitoring in high dependency unit.

Effect of Single Preoperative Dose of Duloxetine on Postoperative Analgesia in Patients Undergoing Total Abdominal Hysterectomy under Spinal Anesthesia.

Background:Women undergoing hysterectomy present a unique set of challenges to the anesthesiologist in terms of postoperative pain management. This study was conducted to see the effect of single-dose perioperative duloxetine 60 mg on postoperative analgesia following abdominal hysterectomy under spinal anesthesia.Materials and Methods:This prospective randomized placebo-controlled study was conducted on 64 patients scheduled to undergo elective abdominal hysterectomy under spinal anesthesia. The patients were divided into two groups of 32 in each, Group D received duloxetine 60 mg 2 h preoperatively and Group P received placebo 2 h preoperatively. Postoperatively, the patients were evaluated by an independent observer for pain on rest and during cough at 0 (arrival at postanesthesia care unit), 2, 4, 6, 12, and 24 h. In addition, the postoperative analgesic requirements and adverse effects were noted.Statistical Analysis Used:Independent t-test/Mann–Whitney U-test was used to compare the pain score between two groups.Results:The demographic data were comparable between both the groups. The mean Visual Analogue Scale scores assessed postoperatively at rest and during cough which were not statistically significant between the two groups. The rescue analgesic consumption in Group D (0.97 ± 0.86) and Group P (1.25 ± 0.76) was comparable and statistically not significant. The total analgesic requirement between duloxetine (4.94 ± 0.84) and placebo (1.25 ± 0.76) group was comparable and statistically not significant. The incidence of nausea vomiting and somnolence was higher in Group D.Conclusion:We conclude that patients receiving a single dose of 60 mg duloxetine as premedication before hysterectomy under spinal anesthesia are no better than placebo on postoperative pain during the first 24 h.

The Impact of Optimal Dose of Ketamine on Shivering Following Elective Abdominal Hysterectomy: A Randomised Comparative Study.

BackgroundFollowing surgery, patients frequently suffer from shivering, and this can lead to postoperative complications and discomfort.ObjectivesThis study aimed to compare the effect of ketamine on patients’ shivering following an elective abdominal hysterectomy. Patients were given either Ketamine (0.25 mg or 0.5 mg/kg) or a placebo. The study and surgery took place in a subspecialty University Hospital for Gynecology and Obstetrics.MethodsThis study was an interventional, randomized, controlled clinical trial. Ninety-six women who underwent elective abdominal hysterectomy were randomly assigned to three groups. Ketamine was administered to all participants 20 min prior to the end of surgery. The first group received 0.25 mg/kg of intravenous ketamine. The second group received 0.5 mg/kg intravenous ketamine. The third group received a placebo of intravenous saline. Postoperative shivering, sedation grade, hallucination, nausea, vomiting, and nystagmus were measured for each patient up to 30 minutes.ResultsThe study showed that patients suffered from less shivering in the two groups that received ketamine. The reduced shivering was seen 5, 10, and 20 min following surgery in the two groups that were given two doses of 0.25 and 0.5 mg/kg ketamine compared to the control group (P value < 0.05). There was a significant difference between patients receiving normal saline and those having 0.25 and 0.5 mg/kg of ketamine in the rate of sedation grade, nausea, vomiting, and nystagmus (P value < 0.05). The main differences in patients receiving ketamine were the sedation grade at zero time and postoperative hallucination experienced by those patients who received 0.5 mg/kg of ketamine.ConclusionsKetamine reduced shivering in all patients following elective abdominal hysterectomy. This was regardless of dose. Patients were less likely to suffer from hallucinations and sedation grade with a lower dose of ketamine (0.25 mg/kg compared to 0.50 mg/kg).

TAKOTSUBO CARDIOMYOPATHY AND CARDIAC ARREST DURING ELECTIVE HYSTERECTOMY AND BILATERAL OOPHORECTOMY

SESSION TITLE: Medical Student/Resident Cardiovascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Takotsubo cardiomyopathy is a form of transient ventricular dysfunction due to severe emotional or physiologic stress. The condition often mimics that of ACS in symptomatology, EKG findings, and elevation of cardiac enzymes. The physiologic mechanism is unknown but is suspected to be related to excess catecholamine release (1). Post-anesthesia Takotsubo has been reported but the pathophysiology here is also not well established (2). Takotsubo-related life-threatening arrhythmias and/or cardiac arrest are sequelae that may be encountered (7). CASE PRESENTATION: A 44yo F (G7P3) with no significant PMH underwent elective total abdominal hysterectomy and bilateral salpingo-oopherectomy for large uterine fibroid and ovarian endometrioma. 25-30 minutes after induction with midazolam, propofol, and rocuronium, the patient’s end-tidal CO2 declined sharply with subsequent hypoxia, hypotension and cardiac arrest. Patient developed multiple episodes of VT/VF, with continued hypoxia and hemodynamic instability despite multiple doses of IV epinephrine and bicarbonate. Bedside echo showed severely decreased EF. She was stabilized with VA ECMO and underwent left heart catheterization and pulmonary angiography, which revealed small distal coronary emboli and small sub-segmental pulmonary embolism. An hour later she developed DIC with signs of abdominal compartment syndrome. After coagulopathy was reversed, she was taken to OR for decompression and completion of initial procedure. Echo the next day showed EF of 25% with apical hypokinesis. 3 days later ECMO was decannulated on and patient was extubated the following day. Echo on hospital day 5 showed EF of 35% with appearance of stress induced cardiomyopathy and no septal defects. DISCUSSION: This case is unique for the intra-operative onset of anesthesia-induced Takotsubo cardiomyopathy with cardiac arrest and coronary artery/pulmonary artery emboli. In our research, we found 8 case reports of Takotsubo after anesthesia induction (1-6). However, none of these described a gynecologic procedure as in our case. CONCLUSIONS: Further research is needed to understand the pathophysiologic relationship between Takotsubo cardiomyopathy and anesthesia induction. Reference #1: Consales, G & Campiglia, L & Michelagnoli, G & Gallerani, E & Rinaldi, S & Pace, S & Gaudio, A. (2008). Acute Left Ventricular Dysfunction Due To Takotsubo Syndrome after Induction of General Anesthesia. Minerva anestesiologica. 73. 655-8. Reference #2: Littlejohn FC, Syed O, Ornstein E, Connolly ES, Heyer EJ. Takotsubo cardiomyopathy associated with anesthesia: three case reports. Cases J. 2008;1(1):227. Published 2008 Oct 8. doi:10.1186/1757-1626-1-227 Reference #3: Gili S, Cammann VL, Schlossbauer SA, et al. Cardiac arrest in takotsubo syndrome: results from the InterTAK Registry. Eur Heart J. 2019;40(26):2142–2151. doi:10.1093/eurheartj/ehz170 DISCLOSURES: No relevant relationships by Joseph Baum, source=Web Response no disclosure on file for Brian Bauman; No relevant relationships by William Bauman, source=Web Response No relevant relationships by Vishal Dahya, source=Web Response No relevant relationships by Rahul Dasgupta, source=Web Response No relevant relationships by Julia Lantry, source=Web Response

Effect of Preoperative Duloxetine on Opioid Consumption in Women Undergoing Abdominal Hysterectomy: A Randomized, Double-Blinded, Placebo-Controlled Trial.

BackgroundPain is one of the most challenging issues following surgery, and it is crucial to provide adequate and appropriate pain control measures.ObjectivesThis study assessed the efficacy of preoperative duloxetine in controlling postoperative pain in women following an abdominal hysterectomy in Yas Hospital affiliated to Tehran University of Medical Sciences between December 2019 and April 2020.MethodsThe study involved 80 women who were candidates for elective abdominal hysterectomy. The participants were randomly assigned to one of two groups. Group 1 received a 60 mg duloxetine capsule two hours before surgery. Group 2 received placebo following the same schedule. The amount of administrated opioids and the time from surgery to the administration of opioids were recorded, along with the frequency of nausea and vomiting experienced.ResultsTwo patients from each group withdrew before the study ended. In total, 38 women in each group were assessed. There were no significant differences in age, duration of surgery, and the amount of administrated opioids between the two groups. However, the number of patients who had nausea and vomiting differed significantly between the two groups (65% vs. 34%; P = 0.006).ConclusionsOur findings showed that duloxetine was not effective in controlling pain after abdominal hysterectomy. In addition, patients who received duloxetine had a significantly higher rate of nausea/vomiting.

Effect of Preoperative Pregabalin on Stress Response during Laryngoscopy, Intubation and Postoperative Analgesia in Normotensive Normoglycemic Patients Undergoing Abdominal Hysterectomy

Abstract Introduction abdominal hyterectomy is common operation and have many indications. Laryngoscopy and intubation induce marked sympathetic hemodynamic effect resulting in cardiac response which may be fatal in some patients. Postoperative pain in the form of hyperalgesia caused by surgical trauma can lead to chronic postoperative pain. Preemptive analgesia is a concept in managing postoperative pain. Preemptive analgesia prevents sensitization of peripheral and central pain pathways caused by tissue damage. Pregbalin is thought to supress the hemodynamic effect of intubation and to have analgesic effect. Aim The aim of this work is to evaluate the effects of different doses of pregabalin as a premedication to attenuate cardiovascular response during laryngoscopy and intubation. Intubation-induced hyperglycemia will be also assessed, in addition to the effect of the drug on postoperative analgesia in normotensive normoglycemic patients undergoing abdominal hysterectomy. Subjects and Methods The current study was performed as a randomized, prospective, placebo-controlled, and double blind study on 120 female patients ASA I, scheduled for elective abdominal hysterectomy under general anesthesia and meeting the inclusion criteria, were allocated into four groups. Group A (n = 30) were given placebo 2 hrs preoperatively, Group B, C and D were given oral pregablin in the following doses 75 mg, 150 mg and 300 mg recpectively. preoperative vital data (systolic blood pressure, diastolic blood pressure, mean blood pressure and heart rate were measured before intubation and after intubation by 2, 4 and 6 minutes. Capillary blood glucose was measured before and after intubation. Intraoperative and postoperative analgesic consumption were recorded. Anesthetic and surgical techniques were standardized. Results The increase in hemodynamic parameters were minimized by pregablinin 150 and 300 mg when compared to the control group and patients received 75 mg. The intraoperative and postoperative consumption of analgesia were decreased in the groups receiving 150 and 300 mg. Conclusion Oral pregablin in 150 and 300 mg in the present study attenuates hemodynamic responses tolaryngoscopy and intubation. Oral pregablin in 150 and 300 mg decreases the consumption of analgesics intraoperatively and postoperatively.

Superior Hypogastric Plexus Blocks for Postoperative Pain Management in Abdominal Hysterectomies.

To evaluate the efficacy of intraoperative superior hypogastric plexus (SHP) blocks on postoperative pain management in abdominal hysterectomies. A total of 78 female American Society of Anesthesiologists grade I or II patients who underwent elective total abdominal hysterectomy for benign reasons were assessed for eligibility. After exclusion of patients who did not fulfill the inclusion criteria, 60 patients were evaluated in 2 groups: patients who had intraoperative SHP block (SHP; n=30), and patients who did not have intraoperative SHP block (No-SHP; n=30). There was no statistically significant difference between the 2 groups in demographic attributes, surgical duration, and length of hospital stay. Opioid requirements in both the postanesthesia care unit and gynecology ward, and nonsteroidal anti-inflammatory drug requirements in the ward were statistically significantly higher in the No-SHP group (P<0.05). Rescue analgesic times were found to be significantly longer in the SHP group (627±352.9 min; P<0.05). All visual analogue scale score assessments were found to be statistically significantly lower in the SHP group (P<0.05). No complications related to the SHP blocks were observed. Intraoperative SHP blocks in abdominal hysterectomies appear to be promising methods for acute postoperative pain management as part of a multimodal analgesia regimen. Although single SHP blocks provide adequate pain relief and reduce analgesic consumption, these blocks might have better results when used together with somatic nerve blocks, including abdominal wall blocks or wound site infiltrations.

Role of preoperative pregabalin in reducing inhalational anesthetic requirements in abdominal hysterectomy: randomized controlled trial.

Preoperative oral pregabalin controls postoperative pain and decreases anesthetic requirements in total intravenous anesthesia. In this study, we hypothesized that preoperative pregabalin reduces inhaled isoflurane requirements. We investigated the effectiveness of preoperative oral pregabalin 150 mg in women undergoing elective open total abdominal hysterectomy under general anesthesia. A prospective, randomized, double-blind, controlled study was conducted in a university hospital. The study included 50 women (18-60 yrs.), ASA I or II, admitted for abdominal hysterectomy under general anesthesia. Exclusion criteria were allergy to pregabalin; calcium channel blockers, antiepileptic drugs, antidepressant drugs, any analgesics, sedatives, or oral hypoglycemic agents. Patients were randomized into two groups; Pregabalin group received oral pregabalin 150 mg and placebo group. Main outcome measures was inhaled isoflurane requirements to maintain hemodynamics ±20% of baseline and bispectral index of 40 - 60, measured using MAQUET Flow-I anesthetic machine. Secondary outcomes were attenuation of pressor response to intubation, postoperative pain, and first time for rescue analgesia, total analgesics and adverse effects. Isoflurane consumption was significantly less in pregabalin group (7.80±1.27 mL h -1) versus (12.27±2.49 mL h-1) in the control group, (P=0.00). Better hemodynamic stability was in pregabalin group. First postoperative hour: the mean VAS Score was significantly higher in control group (7.10±1.20) compared to pregabalin group (4.50±1.70), P<0.001. More dizziness was in pregabalin group. Preoperative pregabalin 150 mg, 1 h before total abdominal hysterectomy has an inhaled anesthetic-sparing effect, maintain hemodynamics and optimizes postoperative analgesia.

Intraoperative transradial angiography augments safe hysterectomy for uterine fibroids in the setting of ambiguous arterial anatomy: a case report

BackgroundTransfemoral access is the traditional gold standard for uterine artery angiography; however, transradial access is gaining in popularity because of its decreased complication profile and patient preference. We present a case of a patient who underwent successful total abdominal hysterectomy for symptomatic uterine fibroids with ambiguous pelvic vasculature that would have been otherwise aborted if it were not for intraoperative transradial access angiography.Case presentationA 52-year-old Caucasian woman presented to her gynecologist for an elective total abdominal hysterectomy and bilateral salpingo-oophorectomy. During preoperative imaging, a 15-cm mass consistent with a uterine fibroid was identified, and the patient’s gynecologist decided to treat her with surgical resection, given the fibroid’s size. The procedure was halted upon discovery of a complicated vascular plexus at the fundus of the uterus, and an intraoperative vascular consult was requested. The vascular operator used a transradial access to perform pelvic angiography in real time to identify the complicated pelvic vasculature, which allowed the gynecologist to surgically resect the uterine fibroid. The patient was discharged on postoperative day 4 without any complications.ConclusionsIntraoperative imaging is a useful technique for the identification of complicated anatomical structures during surgical procedures. The successful outcome of this case demonstrates an additional unique benefit of transradial access and highlights an opportunity for interdisciplinary collaboration for management of complicated surgical interventions.

Comparison of hemodynamic changes between intrathecal dexzmedetomidine 5µg and Fentanyl 25µg as adjuvants to 12.5mg of 0.5% hyperbaric bupivacaine for spinal anesthesia

The application of a single high dose of Dexmedetomidine reduced norepinephrine release by as much as 92% in young healthy volunteers. The release of epinephrine is also reduced by the same amount [51]. The baroreceptor reflex is well preserved in patients who received Dexmedetomidine, and the reflex heart rate response to a pressor stimulus is augmented. These results illustrate that cardiovascular response is evoked mainly by decrease in central sympathetic outflow. After clinical approval of Institutional Ethical Committee Clearance and informed written consent of 90 patients of ASA physical class I and II who were posted for elective Total Abdominal Hysterectomy (TAH). The study population was randomly selected based on the closed sealed opaque envelope technique. The mean duration of surgery in Group-B was 61.00±13.60min, Group-D was 66.33±12.79min and Group-F was 67.33±10.72min. There was no statistically significant difference in the mean duration of surgery among three groups (P>0.05). Statistically there was no significant difference in DBP (mm of Hg) measured at various intervals throughout the surgery among the groups (P>0.05).

Erector spinae plane block for postoperative analgesia in patients undergoing total abdominal hysterectomy: a randomized controlled study original study.

Background: Abdominal hysterectomy is associated with marked postoperative pain and morbidity, but effective postoperative analgesia provides early recovery and ambulation.Aim: We intended to assess the efficacy of bilateral erector spinae plane block (ESPB) on postoperative analgesia in females undergoing abdominal hysterectomy under general anesthesia.Settings and Design: The design was a prospective, randomized, controlled, single-blind clinical study.Patients and Methods: Sixty patients with American Society of Anesthesiologists (ASA) physical status classes Ι to ΙΙΙ were scheduled for elective abdominal hysterectomy under general anesthesia, patients were randomly allocated into two equal groups. ESPB patients received ultrasound-guided ESPB at T9 vertebrae level with 20 ml bupivacaine 0.5%. Control group patients did not receive a block. Total fentanyl consumption in the first 24 h and visual analogue scale (VAS) score for pain were evaluated postoperatively. Unpaired Student’s t-tests, chi-square tests, and Z tests were used to compare groups.Results: No significant differences were recorded between the groups regarding age, weight, ASA physical status, or surgery duration, Total fentanyl consumption in the first 24 h was significantly higher in the control group than the ESPB group (P=0.003; 485±20.39 mcg vs 445±67.49 mcg, respectively), VAS for pain was significantly higher in the control group for the first 12 h postoperatively.Conclusions: Bilateral ESPB provided effective postoperative analgesia and markedly decreased postoperative fentanyl consumption in patients undergoing an abdominal hysterectomy.

Comparison of intravenous lidocaine and dexmedetomidine infusion for prevention of postoperative catheter-related bladder discomfort: a randomized controlled trial

BackgroundCatheter-related bladder discomfort (CRBD) frequently occurs during recovery in patients who undergo intra-operative urinary catheterization. We conducted this study to compare the effect of intravenous lidocaine and dexmedetomidine infusion for preventing CRBD.Methods120 patients undergoing elective open abdominal hysterectomy or hysteromyomectomy requiring urinary bladder catheterization were randomly allocated into three groups of 40 each. Group L received a 2 mg/kg lidocaine bolus followed by infusion of 1.5 mg/kg/h; Group D received a 0.5 μg/kg dexmedetomidine bolus followed by infusion of 0.4 μg/kg/h; Group C received a bolus and infusion of normal saline of equivalent volume. The incidence and different severity (mild, moderate, and severe) of CRBD were assessed on arrival in the postanaesthesia care unit at 0, 1, 2, and 6 h postoperatively.ResultsThe incidence of CRBD was significantly lower in Group L and Group D compared with Group C at 0, 1, and 2 h. However, there was no significant difference among the three groups regarding the different severity of CRBD at all time points. The requirement of rescue tramadol for CRBD was lower in group L and group D than in group C. The incidence of sedation was significantly higher in Group D compared to Group L and Group C, though no difference in other adverse effects was observed.ConclusionsIntravenous lidocaine and dexmedetomidine infusion reduced the incidence of CRBD as well as the additional tramadol requirement for CRBD, but had no effect on the different severity of CRBD.Trial registrationChiCTR-INR-16009162. Registered on 5 September 2016.

Evaluation of the efficacy of 150 micrograms of intrathecal morphine with bupivacaine compared to 250 micrograms for postoperative analgesia following abdominal hysterectomy: a double blinded randomized control study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The synergistic action of local anesthetics and morphine is well known, morphine probably more superior for postoperative analgesia, when compared to other opioids. Preservative-free morphine is now available in India making intrathecal administration possible. The present randomized double blind study was designed to evaluate the effect of adding preservative free morphine to hyperbaric bupivacaine given intrathecally for abdominal hysterectomy.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Following approval by the institutional review board and institutional research grant committee, eighty patients presenting for elective abdominal hysterectomy were included in this randomized, double blind study. All drugs used for spinal anesthesia were autoclaved as per the departmental protocol. 3.5 ml of hyperbaric bupivacaine 0.5% [heavy] was given in both groups along with preservative free morphine according to study group.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 27.5% (11/40) patients in group A, 17.5% (7/40) patients in group B received one dose of rescue analgesia (ketorolac 10 mg),during the 24 hours for pain relief while 29 patients is group A (72.5%) and 82.5% (33/40) patients in group B received 2 doses of rescue analgesia. 10% patients in Group A (4/40) and 10% patients in Group B (4/40) had a sedation score of 1 (drowsy and arousable).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The mean duration of analgesia in patients who received 250 μgms of intrathecal morphine was 18.725±1.38 hours while in patients who received 150 μgms it is 16.075±1.23 hours. We conclude that 250 µgms of preservative-free intrathecal morphine provides longer duration of analgesia when compared to 150 µgms morphine, with hardly any additional adverse effects.&lt;/p&gt;

Low-dose S+ ketamine in target-controlled intravenous anaesthesia with remifentanil and propofol for open gynaecological surgery: A randomised controlled trial.

Background and Aims:Using remifentanil–propofol target-controlled infusion (TCI) in open gynaecological surgeries could be associated with opioid-induced hyperalgesia postoperatively. This study's aim was to investigate the effect of low-dose S-ketamine compared with control on cumulative morphine consumption 24 h postoperatively in women undergoing open abdominal hysterectomy with remifentanil–propofol TCI technique.Methods:Ninety female patients above 21 years old who underwent elective open abdominal hysterectomy under general anaesthesia with remifentanil–propofol TCI were recruited. They were randomised to receive either normal saline as control (n = 44) or 0.25 mg/kg intravenous boluses of S-ketamine before skin incision and after complete removal of uterus (n = 45). The primary outcome measure was cumulative morphine consumption measured over 24 h postoperatively. The secondary outcome measures were incidences of opioid-related and psychotomimetic side effects, pain and level of sedation scores.Results:The cumulative 24-h morphine consumption postoperatively (P = 0.0547) did not differ between both the groups. S-ketamine group had slower emergence from general anaesthesia (P = 0.0308) and lower pain scores (P = 0.0359) 15 min postoperatively. Sedation level, common opioid-related side effects (nausea, vomiting, pruritus), respiratory depression and psychotomimetic side effects were similar between both the study groups.Conclusion:Low-dose S-ketamine did not reduce the total cumulative morphine consumption in patients undergoing major open gynaecological surgeries with remifentanil–propofol TCI.

A Clinico-histopathological Correlation of Elective Abdominal Hysterectomy in University Hospital

Introduction: The objective of this study was to correlate preoperative indications of abdominal hysterectomy with histopathological findings.&#x0D; Methods: This cross-sectional study was conducted in Patan Hospital from April 2016 to March 2018 in all the patients who underwent elective abdominal hysterectomy. Demographic characteristics, clinical symptoms, preoperative diagnosis and final histopathological diagnosis were studied. Preoperative indications were correlated with histopathological diagnosis.&#x0D; Results: A total of 203 elective abdominal hysterectomies were performed. Menorrhagia was the leading symptom found in 67 (33.00%) patients followed by pain abdomen in 62 (30.54%) patients. Leiomyoma was the most common preoperative diagnosis seen in 105 (51.72%) patients followed by ovarian tumor in 34 (16.75%) patients. The most common histopathological diagnosis was leiomyoma observed in 87 (42.86%) patients followed by ovarian tumor in 35 (17.24%) patients. Clinical and histopathological correlation was 100% in cases of ovarian tumor, complex endometrial atypical hyperplasia, pelvic inflammatory disease (PID), fibroid polyp and chronic cervicitis. Only 40% of preoperatively diagnosed postmenopausal bleeding cases were correlated histopathologically while the rest were missed preoperatively which included endometrial polyp (40%) and adult granulosa cell tumor (20%).&#x0D; Conclusions: Leiomyoma was the most common preoperative and histopathological diagnosis. Clinical and histopathological correlation was 100% in cases of ovarian tumor, complex endometrial atypical hyperplasia, PID, fibroid polyp and chronic cervicitis.