End Of Laparoscopic Cholecystectomy Research Articles

Analgesic effects of oxycodone hydrochloride injection after laparoscopic cholecystectomy and influence on substance P, 5-hydroxytryptamine, and patient-controlled intravenous analgesia

Abstract Introduction We sought out to evaluate the effects of oxycodone hydrochloride injection on laparoscopic cholecystectomy (LC), substance P, 5-hydroxytryptamine (5-HT), and patient-controlled intravenous analgesia (PCIA). Materials and Methods A total of 120 eligible patients were randomly divided into an observation group (n=60) and control group (n=60). Oxycodone (0.07 mg/kg) and fentanyl (0.7 μg/kg) were intravenously injected during LC. Substance P and 5-HT were detected by ELISA. Results Heart rate (HR), mean arterial pressure (MAP), and blood oxygen saturation (SpO2) were recorded. Visual analogue scale (VAS), Ramsay scores, and incidence rates of adverse reactions were recorded. The observation group was less prone to agitation, with less affected HR, MAP and SpO2 during recovery. Before and after extubation, and upon leaving the recovery room, substance P and 5-HT increased more slowly in the observation group. After extubation, the control group had higher VAS and Ramsay scores and a higher incidence rate of adverse reactions. Using oxycodone before the end of LC does not delay awakening or affect extubation, but reduces hemodynamic fluctuations, incidence of agitation and release of substance P and 5-HT. It has high safety and stable circulation during recovery. Conclusions Oxycodone used in PCIA after LC effectively mitigates postoperative pain, with milder adverse reactions, which is superior to fentanyl.

A prospective randomized controlled study on the role of restoring liver diaphragm surface tension and pain control at port sites in optimizing pain management following laparoscopic cholecystectomy.

After laparoscopic cholecystectomy (LC), pain is still a significant concern leading to extended hospital stays or readmissions. A standardized strategy is needed to offer effective pain relief postoperatively. The pain in the early postoperative period is mainly due to elimination of intraperitoneal surface tension. The aim of this study is to evaluate the restoration of intraabdominal surface tension and the use of bupivacaine-soaked tachosil to control parietal abdominal pain at the port sites to optimize postoperative pain management. Between March 2020 to December 2021, 816 patients undergoing LC were randomized into two groups after exclusion of 12 patients: Group A-interventional contained 402 patients; Group B-control contained 402 patients. Data to be compared were made in terms of operative time, shoulder pain, upper abdominal pain, and number of analgesic doses and hospital stay. Pain intensity was assessed by using the visual analog scale. There was no significant variation in the demographic data between the two groups. There was significant statistical difference between Groups (A) and (B) regarding severity of shoulder pain and port site pain and number of analgesic doses and hospital stay in favor of Group (A). The results were evaluated within 95% confidence intervals and significance was determined as P< .05. The restoration of intraabdominal surface tension by absorbing as much CO2 as possible at the end of laparoscopic cholecystectomy via the epigastric port route, as well as the use of bupivacaine-soaked tachosil to control parietal abdominal pain at the port sites; both steps significantly improved postoperative pain management, reduced the number of analgesic doses, and decreased the length of hospital stay.

The analgesic effect of nefopam with fentanyl at the end of laparoscopic cholecystectomy.

BackgroundNefopam is a centrally acting analgesic that is used to control pain. The aim of this study was to find an appropriate dose of nefopam that demonstrates an analgesic effect when administered in continuous infusion with fentanyl at the end of laparoscopic cholecystectomy.MethodsNinety patients scheduled for laparoscopic cholecystectomy were randomly assigned to receive analgesia with fentanyl alone (50 µg, Group 1, n = 30), or with fentanyl in combination with nefopam 20 mg (Group 2, n = 30) or in combination with nefopam 40 mg (Group 3, n = 30) at the end of surgery. Pain and side effects were evaluated at 10 minutes, 30 minutes, 1 hour, 2 hours, 6 hours, and 12 hours after arrival in the post-anesthesia care unit (PACU).ResultsPain was statistically significantly lower in Groups 2 and 3 than in Group 1 at 10 minutes, 2 hours, and 6 hours after arrival in the PACU. Nausea was statistically significantly lower in Group 2 than in Groups 1 and 3 at 10 minutes after arrival in the PACU. Shivering was statistically significantly lower in Groups 2 and 3 than in Group 1 at 10 minutes after arrival in the PACU.ConclusionsNefopam is a drug that can be safely used as an analgesic after surgery, and its side effects can be reduced when fentanyl 50 µg is injected with nefopam 20 mg.

Intraperitoneal magnesium sulphate plus bupivacaine for pain relief after laparoscopic cholecystectomy

Background: Multimodal analgesia is necessary for management of pain after laparoscopic cholecystectomy. Magnesium sulphate is a new emerging drug for management of acute pain. This study was performed to study the analgesic efficacy of intraperitoneal bupivacaine and bupivacaine plus magnesium sulphate for postoperative pain relief after laparoscopic cholecystectomy. Methods: At the end of laparoscopic cholecystectomy, 60 patients were randomized to one of the following groups: bupivacaine group receiving intraperitoneal instillation of 30 ml of 0.25% bupivacaine and magnesium sulphate group receiving intraperitoneal instillation of 0.25% bupivacaine plus 50 mg/kg magnesium sulphate to total volume of 30 ml. Postoperative pain was evaluated by using visual analogue scale (standard Visual Analogue Scale pain score of 0-10). Time duration of first analgesia demanded was noted and rescue analgesic was given as tramadol 50 mg intravenously and on demand. Pain, Visual Analogue Scale score and total analgesic consumption was recorded for 24 hours and analysed. Results: The patients who were given intraperitoneal bupivacaine plus magnesium sulphate at the end of surgery had better pain relief in first 24 hours, Visual Analogue Scale score of 0-5 compared to sole bupivacaine group who had Visual Analogue Scale score of 3-7. The magnesium sulphate group had longer pain free period of average 5.53±4.33 hours after surgery compared to 3.16±1.59 hours in sole bupivacaine group. Total analgesic consumption in magnesium sulphate group was also less compared to bupivacaine group (125.0±36.5 and 75.0±25.0 in bupivacaine and magnesium sulphate group respectively). All the results show highly significant differences between the groups. Conclusion: The combined instillation of bupivacaine and magnesium sulphate into the peritoneal cavity at the end of laparoscopic surgery renders patients better pain control and less consumption of analgesics in first 24 hours compared to sole bupivacaine group. DOI: http://dx.doi.org/10.3126/jkmc.v1i1.7251 Journal of Kathmandu Medical College, Vol. 1, No. 1, Issue 1, Jul.-Sep., 2012 pp.21-25

Acute postoperative pain relief, by intraperitoneal application of local anesthetics, during laparoscopic cholecystectomy

Introduction: Intraperitoneal administration of local anesthetic in combination with an opioid, for the relief of postoperative pain, has already been reported after laparoscopic cholecystectomy. This study aimed toassess the analgesic effect of the intraperitoneal administration of bupivacaine and morphine, in patients undergoing laparoscopic cholecystectomy.Methods: 90 patients (30 patients in each group) were included in a double blind, randomized manner. At the end of laparoscopic cholecystectomy, the patients were intraperitoneally treated with 30 ml of: physiologicalsaline (Group 1) or 0.25% bupivacaine (Group 2) or 0.25% bupivacaine + 2 mg morphine (Group 3). Patient’s postoperative pain was evaluated using a visual analogue scale and a verbal rating score. The postoperativeanalgesic requirement was assessed by the total dose of Ketorolak, administered by intravenous or intramuscular route. Pain, vital signs, supplemental analgesics consumption and side effects were recorded for all patients for 12h.Results: There were no difference between the three groups, regarding pain scores (et rest and coughing) during the study, except in the fi rst 6 h, when scores were lower for patients receiving intraperitoneal bipuvacaine+ morphine (p&lt;0.05).Conclusions: In the patients undergoing laparoscopic cholecystectomy, the intraperitoneal administration of bupivacaine + morphine, reduced the analgesic requirements during the fi rst 6 postoperative hours comparedwith the control groups. The combination of intraperitoneal bupivacaine 0.25% and morphine was more effective for treatment of pain after laparoscopic cholecystectomy.

Local anesthesia with ropivacaine for patients undergoing laparoscopic cholecystectomy

To investigate the effect of pain relief after infusion of ropivacaine at port sites at the end of surgery. From October 2006 to September 2007, 72 patients undergoing laparoscopic cholecystectomy (LC) were randomized into two groups of 36 patients. One group received ropivacaine infusion at the port sites at the end of LC and the other received normal saline. A visual analog scale was used to assess postoperative pain when the patient awakened in the operating room, 6 and 24 h after surgery, and before discharge. The amount of analgesics use was also recorded. The demographics, laboratory data, hospital stay, and perioperative complications were compared between the two groups. There was no difference between the two groups preoperatively in terms of demographic and laboratory data. After surgery, similar operation time, blood loss, and no postoperative morbidity and mortality were observed in the two groups. However, a significantly lower pain score was observed in the patients undergoing LC with local anesthesia infusion at 1 h after LC and at discharge. Regarding analgesic use, the amount of meperidine used 1 h after LC and the total used during admission were lower in patients undergoing LC with local anesthesia infusion. This group also had a shorter hospital stay. Local anesthesia with ropivacaine at the port site in LC patients significantly decreased postoperative pain immediately. This explains the lower meperidine use and earlier discharge for these patients.

Effects of Ondansetron and Granisetron on Postoperative Nausea and Vomiting in Adult Patients Undergoing Laparoscopic Cholecystectomy: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

Background: Postoperative nausea and vomiting (PONV) are common and potentially distressing adverse events (AEs) associated with surgery and anesthesia. In patients undergoing laparoscopic cholecystectomy (LC) without antiemetic prophylaxis, the incidence of PONV can be as high as 72%. Objective: The aim of this study was to investigate the prophylactic antiemetic effects of ondansetron and granisetron in patients undergoing LC when these agents are administered before the end of surgery. Methods: Patients classified by the American Society of Anesthesiologist's physical status as I or II who were scheduled for elective LC were included in this randomized, double-blind, placebo-controlled study. Anesthesia was induced with thiopental 5 mg/kg and fentanyl 2 μg/kg, and was maintained with isoflurane 1% to 3% in 50% oxygen and 50% nitrous oxide and fentanyl as needed. Approximately 20 to 30 minutes before the end of the surgery, the patients randomly received either IV ondansetron 100 μg/kg (group O), IV granisetron 40 μg/kg (group G), or normal saline (group P). Plasma levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were determined preoperatively and 24 hours postoperatively. The patients were observed for 24 hours for PONV and other possible AEs. Postoperative pain intensity was determined using a 10-cm visual analogue scale. Four-point satisfaction scores were determined at 24 hours. Results: Ninety patients (69 women, 21 men) participated in the study. Demographic characteristics and operative data (duration of surgery and anesthesia and amount of intraoperative fentanyl) were similar in the 3 groups. The only AE reported by patients during the 24-hour observation period was nonsevere headache. The number of patients experiencing headache was similar in group P, group O, and group G (10 [33%] patients, 6 [20%], and 10 [33%], respectively). No significant changes were found in presurgical and postsurgical plasma levels of ALT and AST in any group. The mean (SD) satisfaction scores in group O and group G (3.0 [0.4] and 3.0 [0.6], respectively) were significantly higher than those in group P (2.5 [0.5]; both, P < 0.01). Immediately after surgery (period 0), significantly more patients in the placebo group (21 [70%]) experienced PONV compared with those in the ondansetron group (9 [30%]; P < 0.05) and the granisetron group (7 [23%]; P < 0.01). During the 24-hour observation period, a significantly greater number of patients in group P (18 [60%]) required a single dose of a rescue antiemetic drug compared with those in groups O and G (9 [30%] and 6 [20%], respectively; both, P < 0.01). Conclusions: Patients administered ondansetron 100 μg/kg or granisetron 40 μg/kg 20 to 30 minutes before the end of LC had significantly higher PONV control during the 24-hour postoperative observation period than patients receiving placebo. However, there were no significant differences between the active treatment groups in the incidence of PONV, patient satisfaction, or AEs.