Postoperative Analgesia In Laparoscopic Cholecystectomy Research Articles

Effectiveness of ESP Block as Post-Operative Analgesia in Comparison with Opioid Analgesia for Laparoscopic Cholecystectomy

Background: In our country, the role of Erector Spinae Plane Block (ESP) for post-operative analgesia in laparoscopic cholecystectomy has not yet been investigated. As a result, the study was designed to compare the effectiveness of ESP block as post-operative analgesia to opioid analgesia for pain control following Laparoscopic Cholecystectomy. Objectives: The aim of the study was to evaluate the effectiveness of ESP block as post-operative analgesia in comparison with opioid analgesia. Methods: This cross-sectional comparative study was conducted at the department of surgery with collaboration of department of Anaesthesiology in CMH for 6 months of period. Before commencement of the study formal ethical clearance was taken from the Ethical Committee of DGMS Army. Total 60 patients, scheduled for laparoscopic cholecystectomy under general anesthesia were included in this study and randomly divided into two groups (30 patients in each group). total 30 Patients, received both GA and ultrasound guided ESP block were assigned as group E and 30 Patients, received GA and opioid analgesia were in group N. Informed written consent was taken from each subject and ethical measures were followed strictly in whole study. Following data collection, data were analyzed by the SPSS 24. Results: In terms of age, sex, BMI and ASA grading, the two groups had identical demographic features (p>0.05 in all cases). There was no significant difference in pre-operative, post-operative, or recovery room heart rate (p>0.05) or mean arterial pressure (p>0.05). In the recovery room, group E has significantly less pain than group N (3.67±0.802 vs 4.3±0.877; p<0.05). A similar improvement was seen in group E at 6, 12 and 24 hours (p<0.05 in all follow ups). Post-operative analgesic consumption was similarly higher in group N at 1, 12, and 24 hours (p<0.05 in all follow up). Except for nausea, which was more common in group N (p<0.05), complications were similar in both groups. ......

Dexmedetomidine versus Dexamethasone as Adjuvant to Bupivacaine in Ultrasound Guided Transversus Abdomins Plane (TAP) Block for Analgesia in Patients Undergoing Laparoscopic Cholecystectomy Surgery

Abstract Background Ultrasound-guided transversus abdominis plane (TAP) block became a common analgesic method after surgery involving the abdominal wall. Different adjuvants have been used to intensify the quality and the duration of local anesthetics. Aim of the Work to compare dexmedetomidine versus dexamethasone added to bupivacaine as adjuvant to the local anesthetic bupivacaine during Ultrasoundguided transversus abdominis plane (TAP) block for postoperative analgesia in laparoscopic cholecystectomy, characteristics including duration of postoperative analgesia, post-operative pain score and sedation score. Patients and Methods The current study included 40 patients scheduled for elective laparoscopic cholecystectomy surgery were given Ultrasound-guided transversus abdominis plane (TAP) block after induction of general anesthesia. The patients were randomly allocated into two groups. Group (DM): patients received 22 ml of Bupivacaine 0.25 %in 20 ml + 1 ug/kg of dexmedetomidine in 2 ml on both sides. Group (DS): patients received 22 ml of Bupivacaine 0.25 % in 20 ml + 4 mg of dexamethasone in 2 ml on both sides. Results VAS pain score at rest especially 6, 12, 24, 48 hrs is significantly less in dexmedetomidine group than in dexamethasone group. VAS pain score at movement especially 6, 12, 24, 48 hrs is significantly less in dexmedetomidine group than in dexamethasone group. 1st rescue dose of analgesics was delayed up to (19.76±2.51 hrs), in dexmedetomidine group in comparison to (12.92±2.17 hrs) in dexamethasone group. The total dose of paracetamol required by patients in the dexmedetomidine group was (3.18±1.07 gm) compared to (5.33±1.16 gm) in dexamethasone group, indicating longer pain-free period and less requirement of analgesia in the dexmedetomidine group. Therefore, use of dexmedetomidine in TAP block has a beneficial effect in reducing the dose of systemic analgesic requirements. Conclusion co administration of 1 ug/kg of dexmedetomidine vs dexamethasone 4 mg to 0.25 % bupivacaine on both sides by US guided TAP block leaded to significant changes in the form of lower HR at 12, 24, 48 hrs, lower sedation score at 1, 6, 12, 24, 48 hrs and no significant changes in systolic blood pressure, diastolic blood pressure, oxygen saturation and respiratory rate.

Comparison between peripheral nerve stimulator-guided serratus anterior plane block versus transversus abdominis plane block for postoperative analgesia in laparoscopic cholecystectomy under general anaesthesia: A double-blind randomised controlled trial.

Laparoscopic cholecystectomy (LC) is a widely accepted surgical procedure associated with postoperative pain. This study was done to compare peripheral nerve stimulator (PNS)-guided serratus anterior plane block (SAP) and transversus abdominis plane (TAP) block for postoperative analgesia for patients undergoing LC. Following approval from the ethical committee, 70 patients for LC were randomly assigned to Group S: SAP block and Group T: TAP block. The blocks were performed under PNS guidance, and 20 ml of 0.375% ropivacaine was administered. The severity of pain was measured using a visual analogue scale (VAS). The study's primary objective was the evaluation of the postoperative VAS score. The time of the first dose of rescue analgesia and total tramadol consumption for 24 h postoperatively were secondary objectives. All the statistical calculation was done using statistical analyses for Social Sciences for Windows version 23.0 (IBM Corp, NY, USA). Lower VAS score was seen in patients of TAP block at rest as well as movement at 6 h (P = 0.001), 12 h (P = 0.001) and 18 h (P = 0.001) postoperatively compared with SAP. The TAP group showed a significantly increased time of first rescue analgesic compared to the SAP group (7.97 ± 0.51 vs. 5.89 ± 1.45, P = 0.001). Tramadol usage was significantly higher in the SAP group than in the TAP group (128.9 ± 36.22 vs. 72.43 ± 44.80, P = 0.001). TAP block guided by the PNS improves postoperative pain with less tramadol consumption and during the postoperative period without significant complications.

A comparative evaluation of intraperitoneal instillation and periportal infiltration of 0.375% ropivacaine with dexmedetomidine and nalbuphine as adjuvants for post-operative analgesia in laparoscopic cholecystectomy

Background: Intraperitoneal instillation (IPI) of local anesthetic agents into peritoneal cavity has proved to be an effective method of post-operative analgesia in laparoscopic cholecystectomy (LC). The addition of adjuvants such as narcotics or α2-agonists has been proposed to prolong the duration of post-operative analgesia. Aims and Objectives: This study aimed to compare post-operative analgesia of IPI and periportal infiltration of ropivacaine plus dexmedetomidine with ropivacaine plus nalbuphine in patients undergoing LC. Materials and Methods: This was a comparative, prospective, randomized controlled double-blind study conducted on total of 100 patients (American Society of Anesthesiologists class I and II) planned for LC who were randomly divided into two groups of 50 patients: Group Ropivacaine+Dexmedetomidine (RD) received IPI and periportal infiltration of 150 mg of ropivacaine (0.375%) and dexmedetomidine (1 μg/kg) diluted with normal saline to 40 mL and Group Ropivacaine+Nalbuphine (RN) received 150 mg of ropivacaine (0.375%) and 10 mg nalbuphine diluted with normal saline to 40 mL. Post-operative pain was assessed by Visual Analogue Score, time to first request of analgesia, and total amount of rescue analgesics given in 24 h and side effects were noted. Data were analyzed by Student’s independent t-test and Chi-square test using SPSS version 20.0. Results: Overall Visual Analog Scale scores (1.38±0.78 vs. 2.59±1.15), time to first request of analgesia (7.3±3.74 vs. 4.2±2.71), and total analgesic consumption (82.4±15.34 vs. 158.5±16.19) were significantly lower in the RD group compared to the RN group. Among post-operative adverse events, the incidence of post-operative nausea and vomiting was significantly higher in the RN group. Conclusion: The addition of dexmedetomidine appears to be superior to nalbuphine in terms of prolonged post-operative analgesia, lesser requirement of rescue analgesia, and less complications.

A Comparison between the Efficacy of Paracetamol Plus Pethidine and Pethidine Alone for Postoperative Analgesia in Laparoscopic Cholecystectomy

A Comparison between the Efficacy of Paracetamol Plus Pethidine and Pethidine Alone for Postoperative Analgesia in Laparoscopic Cholecystectomy

A COMPARATIVE STUDY OF EFFECTIVENESS OF INTRAPERITONEAL INSTILLATION OF BUPIVACAINE IN LAPAROSCOPIC CHOLECYSTECTOMY WITH AND WITHOUT ITS INSTILLATION IN POST-OPERATIVE PAIN MANAGEMENT

Introduction: Laparoscopic cholecystectomy is a gold standard surgical procedure in post-operative pain recovery time. Though it is associated with lesser post-op pain than open cholecystectomy, few patients still experience pain. Pain relief is an important goal of any surgery. Administration of local anaesthetic either during surgery is a method of reducing post-op pain. To Compare the effect of intraperitoneal Aim: instillation of 0.5% bupivacaine with adrenaline and without intraperitoneal instillation of 0.5% bupivacaine with adrenaline for post-operative analgesia in laparoscopic cholecystectomy. A total of 120 participants we Materials & Methods: re considered for this study with 60 participant receiving bupivacaine and other 60 receiving normal saline. VAS/VRS score is measured at 2, 4, 6, 12 & 24 hours after surgery for each group. Results: From the results, we found signicant differences in the mean scores of study group and placebo group. The patients who were given bupivacaine were found to have reduced pain. Conclusion: In our study, we found that bupivacaine reduces postoperative pain. We conclude that the intraperitoneal instillation of bupivacaine is a safe and effective method for providing postoperative analgesia without signicant side effects.

Analgesic Effects of Ropivacaine Combined With Dexmedetomidine in Transversus Abdominis Plane Block in Patients Undergoing Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis

This review aimed to conduct a meta-analysis of published randomized controlled studies (RCTs) comparing the effectiveness of dexmedetomidine (DEX) combined with ropivacaine versus single ropivacaine in transversus abdominis plane block (TAPB) for postoperative analgesia after laparoscopic cholecystectomy (LC). The purpose was to investigate whether DEX combined with ropivacaine in TAPB for postoperative analgesia in LC is superior to single ropivacaine administration. A Systematic Review and Meta-analysis. Five electronic database systems were searched for RCTs on the effects of DEX combined with ropivacaine (joint group) and single ropivacaine on postoperative analgesia in LC. The standardized mean difference (SMD) or odds ratio (OR) and their corresponding 95% confidence interval (CI) of the indicators were calculated for comparison. As of December 23, 2021, 153 articles were retrieved, but only 16 articles were finally included in this meta-analysis. The results showed that compared with single ropivacaine, DEX combined with ropivacaine in TAPB had better analgesia and lighter sedative effect in patients after LC. After LC 2h(T1), 4h(T2), 8h(T3), 12h(T4) and 24h (T5), the joint group participants have lower VAS scores (T1: SMD=-0.32, 95%CI: -0.49, -0.14; T2: SMD=-1.11, 95%CI: -1.56, -0.65; T3: SMD=-2.88, 95%CI: -3.74, -2.02; T4: SMD=-2.56, 95%CI: -3.04, -2.08; T5: SMD=-1.44, 95%CI: -1.81, -1.06). Also, the Ramsay score of the joint group is higher than the single group (T1: SMD=1.05, 95%CI: 0.39, 1.71; T2: SMD=1.57, 95%CI: 0.57, 2.57; T3: SMD=1.64, 95%CI: 0.65, 2.63; T4: SMD=1.72, 95%CI: 0.54, 2.89; T5: SMD=0.57, 95%CI: 0.21, 0.94). The results of this review and meta-analysis suggest that DEX combined with ropivacaine has less postoperative pain, more patients got the status of sober and cooperative, and longer postoperative analgesia lasted than ropivacaine alone in TAPB, especially in the group of combined treatment with 1.0 mcg/kg DEX. Furthermore, the flow dynamics of the two groups are stable, and there is no notable difference in the incidence of adverse reactions.

Comparative study between ultrasound-guided subcostal transversus abdominis plane block and paravertebral block for postoperative analgesia in laparoscopic cholecystectomy

Comparative study between ultrasound-guided subcostal transversus abdominis plane block and paravertebral block for postoperative analgesia in laparoscopic cholecystectomy

Intraperitoneal instillation of bupivacaine and hydrocortisone for postoperative analgesia in laparoscopic cholecystectomy under spinal anaesthesia – A prospective randomized study

Intraperitoneal instillation of bupivacaine and hydrocortisone for postoperative analgesia in laparoscopic cholecystectomy under spinal anaesthesia – A prospective randomized study

Impact of Peroperative Intravenous Lidocaine on Postoperative Analgesia in Laparoscopic Cholecystectomy

The present study was undertaken to evaluate the outcome of peroperative intravenous lidocaine in reducing the intensity of postoperative pain after laparoscopic cholecystectomy.This prospective randomized clinical trial study was conducted in the Department of Anaesthesiology, Sir Salimullah Medical College Mitford Hospital (SSMC MH), Dhaka between April 2014 to September 2014. A total of 80 patients of chronic cholecystitis or cholelithiasis undergoing laparoscopic cholecystectomy in SSMC MH, Dhaka were consecutively included in the study and were randomly assigned to two study groups. Patients in the study group received I/V lidocaine administration @ 3 mg/kg/h and those in the control group received normal saline (0.9% saline) in the same volume by a different observer. When compared the changes in haemodynamic variables from baseline to endpoint of the study shows that there was no significant difference between the groups in terms of heart rate, systolic, diastolic and mean blood pressures except a sudden rise of the parameters at 5 minutes after induction. However, the systolic blood pressure of study group experienced a slight reduction from 30 minutes onwards to the end of the observation and differed significantly from the corresponding SBPs of the control group. The mean BP of both the groups also showed similar trend like systolic BPs.The SpO2 in both study and control groups was maintained at 99 to 100% throughout the study. The study concluded that peroperative infusion of nontoxic dose of lidocaine decreases the intensity of postoperative pain and reduces the postoperative analgesics(inj. Pethidine) requirement without causing any significant adverse effects. Sir Salimullah Med Coll J 2022; 30: 148-154

Is Right Unilateral Transversus Abdominis Plane (TAP) Block Successful in Postoperative Analgesia in Laparoscopic Cholecystectomy?

Background Transversus abdominis plane (TAP) block is used for postoperative analgesia in laparoscopic cholecystectomy. In laparoscopic cholecystectomy, the incisions are located mainly on the upper right side of the abdomen. Aims We aim to determine the efficacy of less-invasive ultrasound-guided right unilateral oblique subcostal TAP block in laparoscopic cholecystectomy on postoperative analgesia by comparing patients undergoing bilateral TAP block and a control group. Methods Ninety patients were equally divided into control, unilateral, and bilateral TAP block groups. TAP blocks were conducted before anesthesia. No block was applied to the control group. Patients' demographics and postoperative pain, satisfaction, and nausea-vomiting scores and tramadol/ondansetron doses were evaluated. Results There was no significant difference in the verbal numerical rating scale for pain scores at rest and during coughing (VNRS-R and VNRS-C) between unilateral and bilateral TAP block groups at postoperative 1 hour, 2 hour, 4 hour, 8 hour, 12 hour, and 24 hours. In addition, VNRS-R and VNRS-C scores were significantly higher in the control group than in the other two groups. Tramadol consumption in the control group was significantly higher than in the unilateral and bilateral TAP block groups (p ≤ 0.01), while no significant difference was identified between unilateral and bilateral TAP block groups (p=0.303). Nausea-vomiting scores and ondansetron consumption did not differ significantly between all the groups. Patient satisfaction was significantly higher in unilateral and bilateral groups (p < 0.01, p < 0.01) than in the control group, while there was no significant difference between unilateral and bilateral TAP block groups (p=0.793). Conclusions Right unilateral TAP block provides postoperative analgesia as effective as bilateral TAP block in laparoscopic cholecystectomy.

To compare the effect of intraperitoneal instillation of ropivacaine 0.75% 10ml, and ropivacaine with dexmedetomidine 1mcg/kg for post-operative analgesia after laparoscopic cholecystectomy

Background: To compare the effect of intraperitoneal instillation of ropivacaine 0.75% 10 ml, and ropivacaine with dexmedetomidine 1mcg/kg for post-operative analgesia after laparoscopic cholecystectomyMaterials and Methods: This is a prospective, randomised study conducted out on 100 patients of either sex, aged 18-60 years, ASA grade I and II scheduled for laparoscopic cholecystectomy.Results: Intra-peritoneal instillation of 0.75%ropivacaine with dexmedetomidine provides superior and prolonged pain relief without any adverse effects, making its use simple, safe and effective for postoperative analgesia in laparoscopic cholecystectomy. All the results were significant statistically and have correlated well with the studies in reference.Conclusion: we concluded that dexmedetomidine 1µg/kg can be used as adjuvant to 0.75% ropivacaine for effective post-operative analgesia in laparoscopic cholecystectomy. Intra-peritoneal instillation of 0.75%ropivacaine with dexmedetomidine provides superior and prolonged pain relief without any adverse effects, making its use simple, safe and effective for postoperative analgesia in laparoscopic cholecystectomy. Hence, we concluded that use of dexmedetomidine as additive to ropivacaine for intra-peritoneal instillation and port site infiltration in patients posted for elective laparoscopic cholecystectomy, as it significantly prolongs duration of analgesia along with minimal side effects as compared to infiltration with ropivacaine alone.

A comparative study to evaluate the efficacy of intraperitoneal instillation of 0.25% levobupivacaine with or without clonidine (0.75 μg/kg) for postoperative analgesia in patients undergoing laparoscopic cholecystectomy

Background: In recent years, the use of intraperitoneal instillation of local anesthetics with adjuvants has become popular for postoperative analgesia in laparoscopic cholecystectomy. This study aimed to compare the analgesic efficacy and safety of levobupivacaine alone or with clonidine as an adjuvant given through intraperitoneal instillation in laparoscopic cholecystectomy under general anesthesia.Material and Methods: In this prospective randomized double-blind study, 100 patients, aged 18–60 years belonging to ASA physical status I or II, were randomly allocated into two groups. Group L (n = 50) received 0.25% levobupivacaine 28 ml + 2 ml normal saline, whereas Group LC (n = 50) received 0.25% levobupivacaine 28 ml + clonidine 0.75 μg/kg (diluted in 2 ml normal saline) as intraperitoneal instillation before removing trocar. The duration of analgesia, pain scores, total number of doses, and amount of rescue analgesic consumed in 24 h, sedation score, hemodynamics, and adverse effects was noted.Results: Duration of analgesia was significantly prolonged in Group LC (744.10 ± 96.72 min) compared to Group L (525.20 ± 67.91 min) (P < 0.05). Pain scores (VAS) were significantly lower in Group LC (P < 0.05). The total number of doses and amount of rescue analgesic consumption in 24 hours were less in Group LC as compared to Group L (P < 0.05). Sedation, hemodynamics, and side effect profile were comparable in two groups (P > 0.05).Conclusion: Clonidine (0.75 μg/kg) was found to be a safe and effective adjuvant to 0.25% levobupivacaine for intraperitoneal instillation in laparoscopic cholecystectomy in terms of prolonged postoperative analgesia, lower pain scores, reduced rescue analgesic consumption along with no significant sedation, hemodynamic changes, and adverse effects.

COMPARATIVE STUDY OF POST OPERATIVE PAIN RELIEF IN LAPAROSCOPIC CHOLECYSTECTOMY WITH PORT SITE AND INTRAPERITONEAL INSTILLATION OF 0.5% BUPIVACAINE WITH ADRENALINE AND PLACEBO

Introduction : Postoperative pain is variable in intensity,character,duration and is the main factor delaying discharge of patients undergoing day-care procedures including laparoscopy and hence adding to hospital cost and stay. Optimal management has a potential for shortening of hospital stay and for speeding up of recovery.AIM :Comparing the effect of port site and intraperitoneal instillation of 0.5% bupivacaine with adrenaline versus saline for post-operative analgesia in laparoscopic cholecystectomy. To assess the need of rescue analgesics in post- operative period in both groups.Material &amp; Method :A comparative study to be performed on 50 cases receive 40 mls of 0.5% bupivacaine as intraperitoneal infiltration and local infiltration of 20 mls of 0.5% bupivacaine in the port sites (5 ml infiltration in each port) versus 50 cases receive 40 ml of normal saline intraperitoneally Discussion :Reduction in post-operative pain with better cosmesis and early return to work have been the goals to improve cost effectiveness and patient satisfaction. Conclusion : We conclude that instillation of local anaesthetic drug intraperitonialy &amp; Port site local anaesthetic agent injection has added benefits in post operative pain

Comparison of Ultrasound-Guided Modified BRILMA Block with Subcostal Transversus Abdominis Plane Block for Postoperative Analgesia in Laparoscopic Cholecystectomy - A Randomized Controlled Trial.

Background and AimsSubcostal Transversus Abdominis Plane (TAP) block is the standard practice for postoperative analgesia following laparoscopic cholecystectomy. This study aimed to compare the efficacy of modified BRILMA Block (blocking the BRanches of Intercostal nerves at the Level of Mid-Axillary line) with Subcostal TAP block for pain relief following laparoscopic cholecystectomy.MethodsSixty cases scheduled for laparoscopic cholecystectomy were randomly divided into two groups: modified BRILMA block (Group B) and Subcostal TAP block (Group T). General anesthesia was standardized for both groups. Blocks were performed with 20 mL of 0.2% Ropivacaine under ultrasound guidance after induction of anesthesia. Patients were administered morphine through patient controlled analgesia (PCA) pump with a bolus dose of 1 mg, 10 min lockout interval, and a basal infusion rate of 0.1 mg/h. The pain was assessed by the Visual Analog Scale (VAS) scores of one to ten. The total morphine consumption, time to first request for rescue analgesia, and VAS scores at rest and with movement, and complications, if any, were recorded.ResultsThe morphine consumption in Group B was 5.67 ± 1.98 mg and in Group T was 5.17 ± 1.85 mg, which was found to be statistically insignificant (p-value = 0.317). The time to first request for rescue analgesia was 759.33 ± 80.29 min in Group B which was comparable to 854 ± 93.01 min in Group T and statistically insignificant (p-value = 0.295). The average VAS scores at rest as well as on movement were comparable in both the groups during the entire 24 h postoperative period. No complications were encountered in our study.ConclusionUltrasound-guided modified BRILMA block is equally efficacious as subcostal TAP block in providing postoperative analgesia with similar morphine consumption and no significant difference in VAS scores at rest and movement following laparoscopic cholecystectomy.Trial Registration NumberCTRI/2020/02/023457.

Bilateral versus unilateral erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: a randomized controlled study

IntroductionLaparoscopic cholecystectomy (LC) is the common surgical intervention for benign biliary diseases. Postoperative pain after LC remains as an important problem, with two components: somatic and visceral. Trocar entry incisions lead to somatic pain, while peritoneal distension with diaphragm irritation leads to visceral pain. Following its description by Forero et al., the erector spinae plane (ESP) block acquired considerable popularity among clinicians. This led to the use of ESP block for postoperative pain management for various operations. Materials and methodsThis study was conducted between January and June 2019. Patients aged between 18 and 65 years with an American Society of Anesthesiologists (ASA) physical status I.ÇôII, scheduled for elective laparoscopic cholecystectomy were included in the study. All the patients received bilateral or unilateral ESP block at the T8 level preoperatively according to their groups. ResultsThere was no significant difference between the groups in terms NRS scores either at rest or while coughing at any time interval except for postoperative 6th hour (p = 0.023). Morphine consumption was similar between the groups but was significantly lower in group B at 12 and 24 hours (p = 0.044 and p = 0.022, respectively). Twelve patients in group A and three patients in group B had shoulder pain and this difference was statistically significant (p = 0.011). DiscussionIn conclusion, bilateral ESP block provided more effective analgesia than unilateral ESP block in patients undergoing elective LC. Bilateral ESP block reduced the amount of opioid consumption and the incidence of postoperative shoulder pain.

Effect of perioperative intravenous lignocaine infusion on postoperative pain in laparoscopic cholecystectomy

Background and Aims: Postoperative pain delays recovery after laparoscopic cholecystectomy which is done as a daycare surgery. Opioid analgesia carries adverse effects like nausea, vomiting and respiratory depression which can affect postoperative recovery. Our aim was to compare lignocaine infusion with saline infusion as perioperative ERAS measure for postoperative analgesia in laparoscopic cholecystectomy. Method: After obtaining ethical clearance, 40 patients undergoing laparoscopic cholecystectomy were randomised by computer generated codes in to two groups A and B. In group B two subjects were moved out of study, so two in group A were also excluded to make the two groups equal. Group A received saline and group B received 2mg/kg/h lignocaine infusion intravenously which were stopped at the end of the surgery. Postoperative pain was assessed by NRS score at definite time intervals 0 (admission to postoperative anesthesia care unit), 2nd, 4th, 6th, 8th, 10th, 12th and 24th hours. Time at which first rescue analgesia was requested, total analgesic requirements, mean NRS score and side effects were noted. Results: At every time interval, patients in lignocaine group had delayed time to request for rescue analgesia, less analgesic requirements and mean NRS. (P value &lt;0.05). No side effects or signs of toxicity were noted in lignocaine group. Conclusion: Perioperative lignocaine infusion is an efficient, safe and cost-effective armamentarium in implementing ERAS in laparoscopic cholecystectomy.

SEVOFLURANE REQUIREMENT TO ATTENUATE STRESS RESPONSE TO PNEUMOPERITONEUM AND POST-OPERATIVE ANALGESIA DURING LAPAROSCOPIC CHOLECYSTECTOMY: INTRATHECAL DEXMEDETOMIDINE VS. FENTANYL. A PROSPECTIVE RANDOMISED STUDY

Background and aims: Laparoscopic cholecystectomy is considered as the gold standard for cholelithiasis with better preservation of surgical anatomy, early recovery and post-operative analgesia but haemodynamic instability due to pneumo-peritoneum is a concern. This study was contemplated to assess the effect of intrathecal dexmedetomidine or fentanyl on end-tidal inhalation agent concentration requirement as an indirect measure of haemodynamic stress response during the creation of pneumo-peritoneum and on post-operative analgesia. Methods: This prospective, randomized, comparative study was conducted in 75 ASA I and II patients with three groups of 25 each. The patients in group-1 received 10µg of intrathecal dexmedetomidine, group-2 50µg fentanyl and group-3 equal volume of normal saline before administration of general anesthesia. We assessed the vital parameters and end-tidal concentration of sevourane requirement before and 10minutes after creation and immediately after deation of pneumo-peritoneum. Post-operative pain scores were measured using Visual analogue scale(VAS) for 24hrs and rescue analgesia was 0.5µg/kg fentanyl in the immediate post-operative period and paracetamol 15mg/kg if the score was ≥4 in the post-operative period. Results: Demographic data were comparable in all the groups. Systolic blood pressure before onset of pneumo-peritoneum(P=0.03),endtidal inhalation agent concentration to maintain stable haemodynamics post-pneumoperitoneum were signicantly low(P=0.036) in group-1 as compared to group-3. Immediate bolus dose requirement of fentanyl after extubationwas signicantly low, and the duration of post-operative analgesia was prolonged(P=0.009) in group-1.Conclusion: Intrathecal dexmedetomidine may be a safe and effective method in alleviating haemodynamic stress response during pneumo-peritoneum and provides adequate post-operative analgesia in laparoscopic cholecystectomy.

A comparison of dexmedetomidine and clonidine premedication in perioperative hemodynamic stability and postoperative analgesia in laparoscopic cholecystectomy

The aim of this study was to compare dexmedetomidine and clonidine premedication in perioperative hemodynamic stability and postoperative analgesia in laparoscopic cholecystectomy.An observational study was conducted in Sir Sunderlal hospital, Banaras Hindu University. The study included ASA I-II patients undergoing laparoscopic cholecystectomy surgery. Patients undergoing general anaesthesia were included in the study. The control group received iv fentanyl, while patients in one experimental group received iv clonidine 1mcg/kg over 15 minutes, 30 minutes before and in another group received iv dexmedetomidine 1mcg/kg over 15 minutes, 30 minutes before the surgery. Heart Rate, SBP, MAP, DBP, ETCO, PCO and Post-Operative Analgesia were compared for the 3 groups. Results were given as mean ± SD. Data collected were analysed using Student’s t-test. Differences were considered statistically significant if P values were &amp;#60;0.05.A total of 90 patients were included and 30 patients each were randomly assigned to one of the 3 groups. Patients who received dexmedetomidine had better haemodynamic control and post-operative analgesia. Patients who received clonidine had better haemodynamic control than control group but not better than the group who received dexmedetomidine.We conclude that Alpha 2 agonists specially dexmedetomidine produce diverse responses including analgesia, anxiolysis, sedation and sympatholysis.

Bilateral Erector Spinae Plane Block for Postoperative Analgesia in Laparoscopic Cholecystectomy: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Erector spinae plane (ESP) block is a novel regional anesthetic technique. Its application for postoperative analgesia has been increasing since 2016; however, its effectiveness remains uncertain and varies according to the type of surgery. This meta-analysis aimed to assess the analgesic efficacy of ESP block in patients undergoing laparoscopic cholecystectomy. Literature searches of electronic databases and manual searches up to June 1, 2020 were performed. Review Manager Version 5.3 was used for pooled estimates. We included only randomized controlled trials (RCTs) in this meta-analysis. The random-effects meta-analysis model was used, and metaregression was applied when appropriate. A total of five RCTs consisting of 250 patients were included (124 in the ESP block group vs. 126 in the control group). Bilateral ESP block showed a significant reduction in postoperative intravenous opioid consumption reported up to 24hours after surgery (mean difference [MD]=-4.46, 95% confidence interval [CI] [-5.50 to -3.42], P<0.001) and in the time to first rescue analgesic (MD=73.27minutes, 95% CI [50.39 to 96.15], P<0.001). According to the results of four studies, the postoperative pain score was lower in the ESP group compared with the control group at both rest and movement. There were no differences between the two groups as concerns nausea (odds ratio [OR]=0.45, 95% CI [0.13 to 1.52], P=0.20) and vomiting (OR=0.37, 95% CI [0.10 to 1.35], P=0.13). No block-related complications were noted. This meta-analysis showed that bilateral ultrasound-guided ESP block could be considered as an effective option to reduce opioid consumption and the time to first rescue analgesic and seems to be also a safe technique in adults undergoing laparoscopic cholecystectomy.