Intraperitoneal Group Research Articles

Exposure to systemic and intrauterine inflammation leads to decreased pup survival via different placental mechanisms

ProblemExposure to systemic maternal inflammation (i.e., maternal sepsis, influenza, human immunodeficiency virus, or pyelonephritis) and intrauterine (IU) inflammation (i.e., chorioamnionitis or preterm labor) have been associated with adverse perinatal sequelae. Whether systemic and localized inflammation leading to adverse outcomes have similar placental mechanisms remain unclear. Method of StudyWe conducted a study by murine modeling systemic and localized IU inflammation with injections of either intraperitoneal (IP) or IU interleukin-1β (IL-1β) and compared fetoplacental hemodynamic changes, cytokine/chemokine expression, and fetal loss. ResultsIU IL-1β exposure reduced offspring survival by 31.1% and IP IL-1β exposure by 34.5% when compared with control pups. Despite this similar outcome in offspring survival, Doppler analysis revealed a stark difference: IU group displayed worsened fetoplacental hemodynamic changes while no differences were found between IP and control groups. While both IU and IP groups had increases in pro-inflammatory cytokines and chemokines, specific gene expression trends differed between the two groups, once again highlighting their mechanistic differences. ConclusionWhile both IP and IU IL-1β exposure similarly affected pup survival, only IU inflammation resulted in fetoplacental hemodynamic changes. We speculate that exposure to maternal systemic and IU inflammation plays a key role in fetal injury by utilizing different placental inflammatory pathways and mechanisms.

Delay in time to adjuvant chemotherapy and its impact on outcome in completely resected advanced ovarian malignancies treated with CRS, CRS+IP and CRS +HIPEC.

e17051 Background: The relationship between initiation time of adjuvant chemotherapy in ovarian cancer and prognosis has remained controversial. This study was done to determine whether time from optimal cytoreductive surgery (CRS) to initiation of adjuvant chemotherapy impacts disease free & overall survival in advanced ovarian carcinoma. Methods: Total of 185 patients with primary advanced epithelial ovarian carcinoma (Stage IIIc or selected Stage IV), underwent optimal cytoreduction (either as upfront or interval) & adjuvant chemotherapy. The analysis of interval between day of surgery and start of adjuvant chemotherapy and its impact on outcome was done. Results: CRS with intraperitoneal (IP) chemotherapy either in the form of IP port or hyperthermic intraperitoneal chemotherapy (HIPEC) was done in 135patients (60+ 75) and CRS alone in 50 patients. The median delay in starting adjuvant chemotherapy was 35 days for the whole cohort (32 days in the CRS group, 34 days in CRS+ IP group and 41 days in CRS+ HIPEC group). Delay in chemotherapy, as defined by more than 42 days had significant impact on DFS in CRS alone group (36 months vs 17 months: p = 0.02) had some impact in patients receiving intraperitoneal chemotherapy (38 versus 28 months; p = 0.78) & no impact on CRS+HIPEC group (35 vs 32 months; p = 0.17). In comparison to HIPEC vs non HIPEC group (CRS & CRS+IP), there was a meaningful impact on DFS with reference to delay in non HIPEC group ( 38 vs 22 months p = .08 whereas in the HIPEC group delay didn’t have any impact(35vs 32 months p = 017). There was trend towards better OS (88 vs 71 months p = 0.49). Conclusions: Delay in starting adjuvant chemotherapy certainly had impact on outcome with respect to CRS & CRS + IP arm (non HIPEC group) whereas the delay didn’t have an impact in the HIPEC group owing to the fact that single dose of chemotherapy during surgery in heated environment may substitute for the delay. However well designed clinical studies needs to be designed to evaluate the impact of single dose of intraperitoneal heated therapy & its interplay in delay on starting adjuvant chemotherapy.

Comparison of therapeutic effects of melatonin by two different routes in focal cerebral ischemic rats

Objective:To explore the therapeutic effects of melatonin by two different routes, by caudal vein and intraperitoneal injection, on cerebral ischemia-reperfusion (IR) injury in adult rats.Methods:60 Sprague-Dawley rats were randomly divided into normal control (CON), middle cerebral artery occlusion (MCAO), intraperitoneal and caudal vein injection groups. Nissl and immunohistochemical staining were used to observe the morphological and quantitative changes of neurons and the expression of cleaved Caspase-3, Fas and FasL proteins in the injured cerebral cortex.Results:More Nissl-stained and NeuN+ cells were observed in both the intraperitoneal and caudal vein injection groups as compared with the MCAO group (P < 0.05), and the number of Nissl-stained and NeuN+ cells in caudal vein injection group was significantly higher than in intraperitoneal injection group at each time point (all P < 0.05). There were fewer cleaved Caspase-3+, Fas+ and FasL+ cells in both intraperitoneal and caudal vein injection groups than that in MCAO group 24 hours and 72 hours after IR (all P < 0.05). Meanwhile, there were significantly fewer cleaved Caspase-3+, Fas+ and FasL+ cells in caudal vein injection group than in intraperitoneal group (all P < 0.05).Conclusions:Melatonin therapy by both intraperitoneal and caudal vein injection could alleviate the expression of cleaved Caspase-3, Fas and FasL proteins in the cerebral cortex in rats after cerebral ischemia reperfusion and protect the neurons from injury, and had neuroprotective effects, and the therapeutic effect by caudal vein injection was better than by intraperitoneal injection.

Randomised prospective study of using intraoperative, intraincisional and intraperitoneal ropivacaine for the early discharge of post-laparoscopic cholecystectomy patients as a day case in a cost-effective way in government setup of low-income and middle-income countries: Opening new horizons

BackgroundPain is the main reason for staying overnight at hospital after an uncomplicated laparoscopic cholecystectomy.ObjectivesA randomised prospective study was planned to compare the efficacy of intraincisional and intraperitoneal use of...

Comparison of postoperative analgesic efficacy of low-dose bolus intravenous dexmedetomidine and intraperitoneal dexmedetomidine with bupivacaine in patients undergoing laparoscopic cholecystectomy: A randomised, controlled trial.

Background and Aims:Recently, low-dose intravenous (IV) dexmedetomidine has been evaluated for obtunding the pneumoperitoneum-induced haemodynamic changes and its analgesic efficacy in laparoscopic cholecystectomy. The aim was to determine the postoperative analgesic efficacy of low-dose bolus of 0.5 μg/kg dexmedetomidine via IV and intraperitoneal (IP) route in laparoscopic cholecystectomy.Methods:Seventy-five patients, aged 18–60 years of ASA physical status I and II, undergoing laparoscopic cholecystectomy under general anaesthesia were included. Patients in Group C received IP bupivacaine. Patients in Group IV received 0.5 μg/kg dexmedetomidine infusion IV after removal of gall bladder along with IP bupivacaine and Group IP received 0.5 μg/kg dexmedetomidine in 40 mL of 0.25% bupivacaine IP. The primary outcome was 'time to first request of analgesia' and the secondary outcomes were 'total consumption of tramadol in 24 hours,' visual analogue scale (VAS) pain score.Results:In total, 75 patients with 25 in each group were included. Time to first request of analgesia was found to be significantly lower in IV (59.68 ± 71.05 min, P = 0.00) and IP group (90.80 ± 80.46 min, P = 0.001) compared tp Group C (59.68 ± 71.05 min). Mean tramadol consumption in 24 hours (152.40 ± 60.958 vs 137.64 ± 52.40 mg) and mean VAS pain score were comparable in both IV and IP groups in the initial 12 h.Conclusion:Low bolus dose of IP dexmedetomidine is as efficacious as IV dexmedetomidine (0.5 μg/kg) along with IP bupivacaine in laparoscopic cholecystectomy.

Analgesic efficacy of intraperitoneal, incisional, and intraperitoneal + incisional levobupivacaine in laparoscopic gynecological surgery

We aimed to investigate the analgesic efficacy of intraperitoneal, incisional, and intraperitoneal + incisional levobupivacaine in laparoscopic gynecological surgery. Group 1 received levobupivacaine 20 mL intraperitoneally, Group 2 received levobupivacaine 20 mL to the trocar wounds, Group 3 received levobupivacaine 20 mL intraperitoneally and levobupivacaine 20 mL to the trocar wounds. Postoperative abdominal pain at rest and during mobilization and shoulder pain were assessed at the 2nd, 4th,12th, and 24th postoperatively by VAS. If VAS was >3, the analgesia was assessed as inadequate, and diclofenac sodium was injected. In addition, time the first analgesic requirement, total analgesic consumption, analgesic effectiveness, and the satisfaction of patients about the analgesic method were recorded during the postoperative period. No significant difference was found between groups with respect to VAS (p>0.05). Patients in Group 2 had a higher postoperative analgesic consumption and lower timing of the first analgesic requirement than Groups 1 and 3, but these differences were not significant (p>0.05). The satisfaction of the patients about the analgesic technique was similar between the groups. The use of levobupivacaine intraperitoneally is an alternative method to reducing of postoperative shoulder and abdominal pain in gynecological laparoscopic surgery. Also, we observed a lower total analgesic consumption and more analgesic effectiveness in intraperitoneal groups than the other. Further studies are needed with different intraperitoneal local anesthetics.

Effect of intravitreal and intraperitoneal cyanidin-3-glucoside injection in oxygen-induced retinopathy mouse model.

Purpose:To evaluate the effect of cyanidin-3-glucoside (C3G) in oxygen-induced retinopathy (OIR) mouse model.Methods:In this experimental study, 10 C57BL / 6J type mice exposed to room air comprised two control groups (n = 5 each; a negative control and a group receiving intravitreal sterile dimethyl sulfoxide [IVS DMSO]). Thirty C57BL / 6J type mice exposed to 75% ± 2% oxygen from postnatal day 7 to postnatal day 12 comprised the OIR groups. On postnatal day 12, these mice were randomized into six groups (n = 5 each): two OIR control groups (negative control and IVS DMSO), two intravitreal C3G groups (300 and 600 ng/μL), and two intraperitoneal C3G groups (0.05 and 0.1 mg/kg). We quantified neovascularization by counting endothelial cell proliferation on the vitreal side of the inner limiting membrane of the retina and examined histological and ultrastructural changes via light and electron microscopy and apoptosis by terminal deoxynucleotidyl transferase deoxy-UTP-nick end labeling.Results:The intravitreal C3G groups yielded lower endothelial cell counts compared with the intravitreal DMSO group. The intraperitoneal high-dose group had lower cell counts compared with the OIR control groups. Electron microscopy revealed significantly less mitochondrial dysmorphology in intravitreal groups and the high-dose intraperitoneal mice. We noted no difference in apoptotic cell count between the controls, low-dose intravitreal, and both intraperitoneal groups. However, apoptotic cell count was significantly higher in the high-dose intravitreal group.Conclusion:C3G suppresses endothelial cell proliferation in an OIR mouse model, leads to a reduced hyperoxia-induced mitochondrial dysmorphology, but increases apoptotic cell death in high concentrations.

Protective role of fucoxanthin in diethylnitrosamine-induced hepatocarcinogenesis in experimental adult rats.

Hepatocellular carcinoma (HCC) accounts for majority of cancer related deaths. Two major risk factors in induction of HCC are chemical and virus, however, the possible mechanisms of their differences remain indefinable. The current study focused on protective role of Fucoxanthin (Fx) in liver affected by diethylnitrosamine (DEN)-induced HCC. In this study, levels of liver enzymes, oxidative stressors, antioxidant status, and lipoproteins were compared both in tissue and blood. Tissues were also analyzed extensively by histological studies using H and E staining and transmission electron microscopy (TEM). Rats were clustered into four groups of six experimental animals. Group I: Control rats were administered isotonic saline intraperitoneal Group II: Animals received 0.01% DEN through drinking water to induce hepatocellular carcinoma. Group III: Animals received 0.01% DEN simultaneously oral supplementation of Fx (50 mg/kg b.w). Group IV: Rats were given Fx alone (50 mg/kg b.w) orally and the treatment is for 15 weeks. Results showed the decrease in body weight, serum albumin, antioxidant enzymes, and increased all the liver enzymes, serum bilirubin, and stress markers in DEN induced rats, where as the simultaneous supplementation of Fx reverted them to normal levels. Administration of only Fx did not show any change. Therefore, Fx may serve as a chemotherapeutic agent against liver cancer.

SMDR1 is essential for sperm mitochondrial coiling around flagella

Exposure to systemic maternal inflammation (i.e., maternal sepsis, influenza, human immunodeficiency virus, or pyelonephritis) and intrauterine (IU) inflammation (i.e., chorioamnionitis or preterm labor) have been associated with adverse perinatal sequelae. Whether systemic and localized inflammation leading to adverse outcomes have similar placental mechanisms remain unclear.We conducted a study by murine modeling systemic and localized IU inflammation with injections of either intraperitoneal (IP) or IU interleukin-1β (IL-1β) and compared fetoplacental hemodynamic changes, cytokine/chemokine expression, and fetal loss.IU IL-1β exposure reduced offspring survival by 31.1% and IP IL-1β exposure by 34.5% when compared with control pups. Despite this similar outcome in offspring survival, Doppler analysis revealed a stark difference: IU group displayed worsened fetoplacental hemodynamic changes while no differences were found between IP and control groups. While both IU and IP groups had increases in pro-inflammatory cytokines and chemokines, specific gene expression trends differed between the two groups, once again highlighting their mechanistic differences.While both IP and IU IL-1β exposure similarly affected pup survival, only IU inflammation resulted in fetoplacental hemodynamic changes. We speculate that exposure to maternal systemic and IU inflammation plays a key role in fetal injury by utilizing different placental inflammatory pathways and mechanisms.

Retro-rectus placement of bio-absorbable mesh improves patient outcomes.

There is little consensus on the ideal anatomical placement of bio-absorbable mesh. We hypothesized that retro-rectus placement of bio-absorbable mesh would significantly reduce recurrence rates when compared to intraperitoneal mesh placement. A retrospective review was conducted of patients who underwent open complex ventral hernia repair using bio-absorbable mesh (Bio-A, Gore, Flagstaff, AZ). Patient demographics and Centers for Disease Control wound type were collected. A total of 81 patients were included. Seventy-four (91.4%) of these hernia repairs had mesh in the retro-rectus position, while 7 (8.6%) had intraperitoneal mesh placement. Patient demographics, including preoperative comorbidities, did not differ between groups. The retro-rectus group trended to have larger hernia defects (156.2cm2) compared to the intraperitoneal group (63.9cm2) (p = 0.058). Overall complications (e.g., dehiscence, wound drainage, cellulitis, sepsis) were also similar in both groups of patients. Recurrence rates in the retro-rectus and intraperitoneal group were 8.1% and 42.9%, respectively (p = 0.005). When evaluating only patients with CDC class 1 wounds, the recurrence rate in the retro-rectus group was 8.2% and the intraperitoneal group was 50% (p = 0.02). Overall, the average patient follow-up was 22months and did not differ between groups. Both the retro-rectus and intraperitoneal groups indicated a significant (p < 0.05) improvement in quality of life from baseline. No long-term (> 7days) antibiotics were used and no mesh implants were removed during the study. Patients who underwent open complex ventral hernia repairs with bio-absorbable mesh in the retro-rectus position experienced lower overall complication rates than those with intraperitoneal mesh placement. Despite a larger hernia defect in the retro-rectus group, recurrence rates were significantly reduced with retro-rectus placement of mesh compared to intraperitoneal placement. In addition, recurrence rates using bio-absorbable mesh in clean wounds are comparable to previously published recurrence rates with permanent mesh.

Effects of erythropoietin administrated by intranasal on nerve function and CD31 in cerebral ischemia reperfusion rats

Objective To explore the protective effect of erythropoietin(EPO) administrated by intranasal on cerebral ischemia reperfusion in rats with acute cerebral infarction reperfusion. Methods Total of 100 SD rats were divided into model control group, sham operation group, intraperitoneal administration group (IPEPO group), nasal saline group (INNS group) group, and nasal drug delivery group (INEPO group) with 20 in each group.The middle cerebral artery occlusion model of rat was established by thread embolism method and the NSS method was used to evaluate the neural behavior of rats.The expression of EPO in peripheral blood, cerebrospinal fluid and brain regions of rats were detected by Elisa.The vascular endothelial growth factor(VEGF) in brain was detected by immunofluorescence and then the density of newborn blood vessels in the brain was measured. Results Fifteen days after the operation, the NSS score of INEPO group(3.80±1.61) was significantly lower than that of IPEPO group (11.53±2.11), and the difference was statistically significant(P<0.01). And the levels of EPO in blood, cerebrospinal fluid and different brain regions of rats in INEPO group were higher than that of INNS group(all P<0.01). Compared with IPEPO group, the level of EPO cerebrospinal fluid and different brain regions of rats in INEPO group increased obviously, the difference was statistically significant (all P<0.01), and the EPO concentration of the olfactory bulb was the most obvious(INEPO group: (1 456.90±128.22)pg/ml, IPEPO group: (426.11±36.68)pg/ml, P<0.01). Seventy-two hours after operation, the expression of CD31 in ischemic penumbra of rats of model control group (18.21±3.45), INNS group(18.54±2.58), IPEPO group(27.01±2.13)and INEPO group(35.52±2.79)was increased compared with sham operation group (5.14±1.28), and the difference was statistically significant (all P<0.05). The expression of CD31 in IPEPO group and INEPO group was significantly higher than that in INNS group (P<0.05). In INEPO group, the expression of CD31 increased significantly compared with that of IPEPO group (P<0.05). Conclusion Nasal administration of EPO can effectively improve the neurological function of rats with ischemia-reperfusion, and increase the expression of CD31 in the brain tissue of rats.The effect of nasal administration is better than that of intraperitoneal administration. Key words: Nasal administration; Erythropoietin; Ischemia reperfusion; Cerebral infarction; Angiogenesis; Rat

Comparison of intraperitoneal versus intravenous dexamethasone on postoperative nausea and vomiting after gynecological laparoscopy: a randomized clinical trial

BackgroundPostoperative nausea and vomiting (PONV) is a common complication following laparascopic surgery. This study compared the effect of intraperitoneal versus intravenous dexamethasone for reducing PONV after gynecological laparoscopic surgeries.MethodsEighty adult female patients, American Society of Anesthesiologists physical status I–II, scheduled for gynecological laparoscopic surgery were randomized to receive 8 mg dexamethasone intravenously (IV) (n = 40) or intraperitoneally (IP) (n = 40). The primary outcome was the PONV incidence during the first 24 h after laparoscopy. Secondary outcomes included visual analogue scale (VAS) pain scores, total rescue analgesic consumption during the first 24 h postoperatively, the need for rescue antiemetic drugs, and the incidence of complications that may accompany these medications.ResultsEleven women (27.5%) in the IV group, versus only 3 (7.5%) women in the IP group, experienced nausea during the first 24 h postlaparoscopy (P = 0.037). However, 5 patients (12.5%) in the IV group, versus only 2 patients (5.0%) in the IP group, experienced vomiting (P = 0.424). No statistically significant differences were seen in the severity of nausea or the need for rescue antiemetics. The IV group had a higher rate of side-effects than the IP group (27.5% vs. 7.5%, P = 0.037). Headache and dizziness were common side effects in the IV dexamethasone group. The groups did not differ significantly in terms of mean VAS score for pain and total meperidine consumption during the first 24 h postoperatively.ConclusionsIntraperitoneal dexamethasone at a dose of 8 mg at the end of gynecological laparoscopy reduces the incidence of postoperative nausea.

The effect of polypropylene mesh on different layers to the formation of collagen type I/ III ratio and total collagen density in incisional hernia repair

Background: In incisional hernia patients, collagen type I/III ratio and total collagen density (TCD) emerges a main etiological factor. If they are low, recurrence risk can be high. The aim of this study was to determine the ratio of collagen type I/III and TCD after incisional hernia repair in different layers with polypropylene mesh.Methods: In the study, 40 Wistar Albino rats were used. They were divided into four equal groups: control, preperitoneal, intraperitoneal and onlay. In control group, defect was repaired with prolene suture. In other groups, prolene mesh was placed to the different layers. Incisions were reopened 30 days later, and tissue samples were taken. Samples were stained by double-immunohistochemical methods and examined under light microscope.Results: Collagen type I/III ratio and TCD was highest in preperitoneal group. Intraperitoneal group was the second highest group. There was no difference between onlay and control group for collagen type I/III ratio except TCD. There was a significant correlation between TCD and collagen type I/III ratio in all samples.Conclusions: Mesh repair in different layers has an effect on TCD and collagen type I/III ratio in incisional hernia repair. Preperitoneal layer is better than other layers.

Comparative Study between Intravenous and Intraperitoneal Magnesium Sulphate as Adjuvant to General Anesthesia for Pain Management in Laparoscopic Cholecystectomy

Background: numerous researches have proved the benefits of laparoscopic cholecystectomy compared to the open method, mainly because of less metabolic response to stress, maintenance of diaphragm and pulmonary function, less postoperative complications, lower incidence of postoperative ileus, early mobilization, shorter hospital stay, and a more cosmetic. The main presentation of postoperative pain is somatic, whereas visceral pain is less present, and thus the pain is less in the patients operated by laparoscopic method. Aim of the Work: to compare intravenous Magnesium Sulphate with intra peritoneal Magnesium Sulphate as adjuvant to general anesthesia for pain management in laparoscopic cholecystectomy. Patients and Methods: this prospective randomized double blind clinical study using closed envelopes method was carried out on 100 adult patients, Undergoing laparoscopic cholecyctectomy in Bab-Alshaeria University Hospital, faculty of medicine, Al-Azhar University. After approval by the Institutional Ethical Committee, and informed written consent obtained from the patients, we randomly divided the patients into two groups 50 patients each. Results: the pain scores of group II (intra-peritoneal group) were significantly lower than group I (intravenous group), the total opioid consumption postoperatively in group II(intra-peritoneal group) was highly significant lower than group I (intravenous group). Also there was a significant reduction in opioid-related side effects such as postoperative nausea and vomiting. Conclusion: the intraperitoneal administration of magnesium sulphate is a safe and effective method in the management of acute postoperative pain after laparoscopic cholecystectomy more than intravenous administration of magnesium sulphate.

Comparative Study between Intravenous and Intraperitoneal Magnesium Sulphate as Adjuvant to General Anesthesia for Pain Management in Laparoscopic Cholecystectomy

Background: numerous researches have proved the benefits of laparoscopic cholecystectomy compared to the open method, mainly because of less metabolic response to stress, maintenance of diaphragm and pulmonary function, less postoperative complications, lower incidence of postoperative ileus, early mobilization, shorter hospital stay, and a more cosmetic. The main presentation of postoperative pain is somatic, whereas visceral pain is less present, and thus the pain is less in the patients operated by laparoscopic method. Aim of the Work: to compare intravenous Magnesium Sulphate with intra peritoneal Magnesium Sulphate as adjuvant to general anesthesia for pain management in laparoscopic cholecystectomy. Patients and Methods: this prospective randomized double blind clinical study using closed envelopes method was carried out on 100 adult patients, Undergoing laparoscopic cholecyctectomy in Bab-Alshaeria University Hospital, faculty of medicine, Al-Azhar University. After approval by the Institutional Ethical Committee, and informed written consent obtained from the patients, we randomly divided the patients into two groups 50 patients each. Results: the pain scores of group II (intra-peritoneal group) were significantly lower than group I (intravenous group), the total opioid consumption postoperatively in group II(intra-peritoneal group) was highly significant lower than group I (intravenous group). Also there was a significant reduction in opioid-related side effects such as postoperative nausea and vomiting. Conclusion: the intraperitoneal administration of magnesium sulphate is a safe and effective method in the management of acute postoperative pain after laparoscopic cholecystectomy more than intravenous administration of magnesium sulphate.

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.

Intravenous Local Anaesthetic Compared with Intraperitoneal Local Anaesthetic in Abdominal Surgery: A Systematic Review

Modern perioperative care strategies aim to optimise perioperative care by reducing the body's stress response to surgery. A major facet of optimising an abdominal surgery analgesia programme is using a multimodal opioid sparing approach. Local anaesthetics have shown promise and there has been considerable research into the most effective route for their administration. This review aims to determine if there is a difference in analgesic efficacy between intraperitoneal local anaesthetic (IPLA) and intravenous local anaesthetic (IVLA). In concordance with the PRISMA statement, a literature search was conducted to identify randomised control trials that compared IVLA with IPLA in abdominal surgery. The primary outcomes of interest were opioid analgesia requirements and pain score assessed by visual analogue score. Data were extracted and entered into pre-designed electronic spreadsheets. This review has identified six papers that compared intravenous lignocaine to intraperitoneal lignocaine. This review showed significantly lower morphine consumption at 4 and 24h in the intraperitoneal group. There was no significant difference in pain scores. From the analysis of these studies, intraperitoneal local anaesthetic had an analgesic benefit over intravenous lignocaine with regard to decreased opioid consumption for abdominal surgery. Further research investigating IVL combined with intraperitoneal local anaesthetic is warranted.

Does the primary route of spread have a prognostic significance in stage III non-serous epithelial ovarian cancer?

BackgroundThe purpose of this retrospective study was to determine the prognosis of non-serous epithelial ovarian cancer (EOC) patients with exclusively retroperitoneal lymph node (LN) metastases, and to compare the prognosis of these women to that of patients who had abdominal peritoneal involvement.MethodsA multicenter, retrospective department database review was performed to identify patients with stage III non-serous EOC at 7 gynecologic oncology centers in Turkey. Demographic, clinicopathological and survival data were collected. The patients were divided into three groups based on the initial sites of disease: 1) the retroperitoneal (RP) group included patients who had positive pelvic and /or para-aortic LNs only. 2) The intraperitoneal (IP) group included patients with > 2 cm IP dissemination outside of the pelvis. These patients all had a negative LN status, 3) The IP / RP group included patients with > 2 cm IP dissemination outside of the pelvis as well as positive LN status. Survival data were compared with regard to the groups.ResultsWe identified 179 women with stage III non-serous EOC who were treated at 7 participating centers during the study period. The median age of the patients was 53 years, and the median duration of follow-up was 39 months. There were 35 (19.6%) patients in the RP group, 72 (40.2%) in the IP group and 72 (40.2%) in the IP/RP group. The 5-year disease-free survival (DFS) rates for the RP, the IP, and IP/RP groups were 66.4%, 37.6%, and 25.5%, respectively (p = 0.002). The 5-year overall survival (OS) rate for the RP group was significantly longer when compared to those of the IP, and the IP/RP groups (74.4% vs. 54%, and 36%, respectively; p = 0.011). However, we were not able to define “RP only disease” as an independent prognostic factor for increased DFS or OS.ConclusionsPrimary non-serous EOC patients with node-positive-only disease seem to have better survival when compared to those with extra-pelvic peritoneal involvement.

Preventive Potential of Resveratrol in Carcinogen-Induced Rat Thyroid Tumorigenesis.

Thyroid cancer (TC) is the most common endocrine malignancy without reliable preventive agent. Resveratrol possesses in vitro anti-TC activities; while its effect(s) on thyroid tumorigenesis remains unknown. This study aims to address this issue using DEN/MNU/DHPN-induced rat carcinogenesis model. 50 male Sprague-Dawley rats were separated into four groups as Group-1 (5 rats); normally fed; Group-2 (15 rats); DEN/MNU/DHPN treatment only; Group-3 (15 rats) and -4 (15 rats); DEN/MNU/DHPN treatment; followed by resveratrol intragastric (IG) injection and intraperitoneal (IP) injection; respectively; in two-day intervals for 30 weeks. The results revealed that the average resveratrol concentration in thyroid tissues was 1.278 ± 0.419 nmol/g in IG group and 1.752 ± 0.398 nmol/g in IP group. The final body weights of Group-3 and Group-4 were lighter than that (p > 0.05) of Group-1; but heavier than Group-2 (p < 0.05). TC-related lesions (hyperplasia and adenomas) were found in 53.3% of Group-2; 33.3% Group-3 and 26.7% Group-4. Lower serum carcino-embryonic antigen (CEA) and thyroglobulin (Tg) levels; down-regulated expression of IL-6 and cyclooxygenase-2 (COX-2); reduction of NF-κB/p65 nuclear translocation; and elevated IkBα expression were found in the thyroid tissues of Group-3 and Group-4 in comparison with that of Group-2. These results demonstrate that IG and IP administered resveratrol efficiently reduces the frequency and severity of DEN/MNU/DHPN-caused TC-related lesions and would be of values in thyroid tumor prevention.

Randomized controlled study of intraincisional infiltration versus intraperitoneal instillation of standardized dose of ropivacaine 0.2% in post-laparoscopic cholecystectomy pain: Do we really need high doses of local anesthetics-time to rethink!

Earlier studies done to compare the efficacy of use of local anesthetics at intraperitoneal location versus intraincisional use had utilized equal amount of drugs at the two locations, usually 10-20ml. Using this large amount of drug in the small space of intraincisional location as compared to similar amount of drug in large intraperitoneal space created an inadvertent bias in favor of patients receiving the drug intraincisionally so these patients naturally experienced less pain. To conduct a randomized, triple-blind, placebo-controlled study by standardizing dose of local anesthetic, to compare the effectiveness of intraperitoneal against intraincisional use of ropivacaine 0.2% for post-laparoscopic cholecystectomy pain relief. 294 patients underwent elective 4-port laparoscopic cholecystectomy. Patients were triple blindly randomized. All patients received ~ 23ml of solution, of which 20ml was given intraperitoneally (1ml/cm; 16ml along right hemi-dome and 4ml in gall bladder fossa) and ~ 3ml intraincisionally (1ml/cm of length of incision). Solution was either normal saline or drug (0.2% ropivacaine) depending on the group [controls (n = 86), intraperitoneal group (n = 100), and intraincisional group (n = 108)]. 5 different pain scales were used for assessment of overall pain. Pain scores were assessed at 5 points of time. Patients in intraincisional group showed significantly less overall pain and rescue analgesia requirement (p < 0.05). Intraincisional group showed significantly less overall pain (p < 0.05) as compared to intraperitoneal group; however, use of rescue analgesia was comparable in the two groups (p > 0.05); and shoulder pain was significantly less in intraperitoneal group (p < 0.05). The intraincisional use of injection ropivacaine at its minimum concentration of 0.2% in minimal doses of 1ml/cm at the end of procedure provides significantly more post-operative analgesia as compared to intraperitoneal group and controls. However, for controlling shoulder pain, the use of intraperitoneal ropivacaine is desirable.