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Güngördük K, Selimoğlu B, Gülseren V, Yasar E, Comba C, Özdemir İA. Effect of abdominal hot pack application on gastrointestinal motility recovery after comprehensive gynecologic staging surgery. Int J Gynaecol Obstet 2024; 164:1108-1116. [PMID: 37800343 DOI: 10.1002/ijgo.15181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/12/2023] [Accepted: 09/20/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE To evaluate whether abdominal hot water pack application improves gastrointestinal motility following gynecological oncology surgery. METHODS The study was registered at ClinicalTrials.gov (NCT04833699). (https://clinicaltrials.gov/ct2/show/NCT04833699?cond=NCT04833699&draw=2&rank=1). In this randomized controlled trial, participants were randomly assigned (1:1) to the hot water pack group (standardized enhanced recovery protocols plus rubber water bag with a fluffy cover filled with boiled tap water [80°C] and placed on the abdomen at 3, 6, 9, and 12 h postoperatively for 30 min each time) or the control group (standardized enhanced recovery protocols). A subumbilical or supraumbilical vertical midline incision was made to perform staging surgery procedures, including hysterectomy, salpingo-oophorectomy with retroperitoneal lymphadenectomy. The primary outcome was the time to first passage of flatus from the end of the staging procedure. RESULTS In total, 121 women were randomized to the control (n = 62) or hot water pack (n = 59) group. The use of an abdominal hot water pack significantly reduced the mean time to passing first flatus (25.2 ± 3.6 vs. 30.6 ± 3.9 h; hazard ratio [HR] = 4.4; 95% confidence interval [CI]: 2.8-7.1; P < 0.0001), mean time to first bowel movements (28.4 ± 4.0 vs. 34.4 ± 4.5 h; HR = 4.9; 95% CI: 3.0-7.9; P < 0.0001), mean time to first defecation (33.4 ± 4.9 vs. 41.0 ± 7.6 h; HR = 4.3; 95% CI: 2.1-6.8; P < 0.0001), and mean time to tolerating solid diet (2.1 ± 0.6 vs. 2.8 ± 1.0 days; HR = 4.4; 95% CI: 2.2-8.7; P < 0.0001) compared to the control group. The postoperative ileus incidence was significantly lower in the hot water pack group (3.4%) than the control group (16.1%) (P = 0.01). CONCLUSION Abdominal hot water pack application improved gastrointestinal function recovery in women following surgical staging procedures for gynecological malignancy.
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Affiliation(s)
- Kemal Güngördük
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Berfin Selimoğlu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Varol Gülseren
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Eylem Yasar
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Cihan Comba
- Division of gynecologic Oncology, Department of Obstetrics and Gynecology, Bakırköy Sadi Konuk Education and Research Hospital, İstanbul, Turkey
| | - İsa Aykut Özdemir
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medipol University, İstanbul, Turkey
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Güngördük K, Gülseren V, Taştan L, Özdemir İA. Paracervical block before laparoscopic total hysterectomy: A randomized controlled trial. Taiwan J Obstet Gynecol 2024; 63:186-191. [PMID: 38485313 DOI: 10.1016/j.tjog.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVE To test the hypothesis that paracervical block with 0.5 % bupivacaine decreases postoperative pain after total laparoscopic hysterectomy (TLH). MATERIALS AND METHOD This randomized double-blind placebo control trial included 152 women. We injected 10 mL 0.5 % bupivacaine (study group, n = 75) or 10 mL normal saline (control group, n = 77) at the 3 and 9 o'clock positions of the uterine cervix. The primary outcome was the visual analog scale score (VAS) determined 1 h (h) postoperatively. RESULTS The 152 patients did not differ in their baseline demographics or perioperative characteristics. The mean VAS 1 h postoperatively was significantly lower in the study group than in controls (5.7 ± 1.2 vs. 6.8 ± 1.1, P < 0.001). The average VAS at 30 min, 3 h, and 6 h postoperatively was also significantly lower in the study group. Patients in the study group had a significantly lower analgesic requirement than did controls during the first 24 h postoperatively (6 [7.8 %] vs. 16 [21 %], P = 0.021). Total QoR-40 questionnaire scores were higher in patients who received bupivacaine. CONCLUSION Paracervical bloc with 0.5 % bupivacaine just before TLH is an effective and safe method to reduce pain and lower postoperative analgesic requirement. URL LINK THAT LEADS DIRECTLY TO THE TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT05341869?cond=NCT05341869&draw=2&rank=1.
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Affiliation(s)
- Kemal Güngördük
- Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Turkey
| | - Varol Gülseren
- Erciyes University, Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Kayseri, Turkey.
| | - Leyla Taştan
- Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Turkey
| | - İsa Aykut Özdemir
- Medipol University, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Turkey
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Tian H, Qi H, Xu X, Yu T, Lin X. Research hotspots and trends in postlaparoscopic shoulder pain from 2003 to 2023: A bibliometric analysis. Heliyon 2024; 10:e25846. [PMID: 38390189 PMCID: PMC10881854 DOI: 10.1016/j.heliyon.2024.e25846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/24/2024] Open
Abstract
The incidence of postlaparoscopic shoulder pain has recently increased and has attracted increasing attention from clinical workers, but no study has performed bibliometric and visual analysis of the relevant literature. This study used bibliometric and visual analysis to conduct a comprehensive and systematic evaluation of postlaparoscopic shoulder pain to help researchers understand the latest global trends and hotspots and provide a reference for caregivers to carry out PLSP care interventions and research. Related studies on postlaparoscopic shoulder pain from 2003 to 2023 were retrieved from the Web of Science Core Collection. We analysed current research trends and hotspots in this field using VOSviewer and CiteSpace. A total of 2451 authors from 352 institutions in 50 countries published 464 studies related to postlaparoscopic shoulder pain. The United States was the country with the most publications and worked closely with other countries. Donmez Turgut was the researcher with the most published articles, while Bisgaard T had the most citations per article. The Journal of Surgical Endoscopy was cited most frequently, totalling 356 times. Through keyword significance analysis, we found that relieving postlaparoscopic shoulder pain in patients through integrated care interventions was an emerging research hotspot. This bibliometric and visual analysis provides a comprehensive review of studies related to postlaparoscopic shoulder pain. The current global research trend and hotspot is to alleviate postlaparoscopic shoulder pain through integrated care interventions, but the advantages of this approach are not outstanding. However, further research and global collaboration are still needed. Our findings can help researchers understand the current status of postlaparoscopic shoulder pain research and identify new directions for future research.
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Affiliation(s)
- Hefeng Tian
- Operating Room, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haiou Qi
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xin Xu
- Operating Room, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ting Yu
- Operating Room, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xianping Lin
- Operating Room, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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De Cassai A, Sella N, Geraldini F, Tulgar S, Ahiskalioglu A, Dost B, Manfrin S, Karapinar YE, Paganini G, Beldagli M, Luoni V, Ordulu BBK, Boscolo A, Navalesi P. Single-shot regional anesthesia for laparoscopic cholecystectomies: a systematic review and network meta-analysis. Korean J Anesthesiol 2023; 76:34-46. [PMID: 36345156 PMCID: PMC9902189 DOI: 10.4097/kja.22366] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/05/2022] [Accepted: 11/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Different regional anesthesia (RA) techniques have been used for laparoscopic cholecystectomy (LC), but there is no consensus on their comparative effectiveness. Our objective was to evaluate the effect of RA techniques on patients undergoing LC using a network meta-analysis approach. METHODS We conducted a systematic review and network meta-analysis. We searched PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science (Science and Social Science Citation Index) using the following PICOS criteria: (P) adult patients undergoing LC; (I) any RA single-shot technique with injection of local anesthetics; (C) placebo or no intervention; (O) postoperative opioid consumption expressed as morphine milligram equivalents (MME), rest pain at 12 h and 24 h post-operation, postoperative nausea and vomiting (PONV), length of stay; and (S) randomized controlled trials. RESULTS A total of 84 studies were included. With the exception of the rectus sheath block (P = 0.301), the RA techniques were superior to placebo at reducing opioid consumption. Regarding postoperative pain, the transversus abdominis plane (TAP) block (-1.80 on an 11-point pain scale) and erector spinae plane (ESP) block (-1.33 on an 11-point pain scale) were the most effective at 12 and 24 h. The TAP block was also associated with the greatest reduction in PONV. CONCLUSIONS RA techniques are effective at reducing intraoperative opioid use, postoperative pain, and PONV in patients undergoing LC. Patients benefit the most from the bilateral paravertebral, ESP, quadratus lumborum, and TAP blocks.
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Affiliation(s)
- Alessandro De Cassai
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Nicolò Sella
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Federico Geraldini
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Serkan Tulgar
- Department of Anesthesiology and Reanimation, Samsun Training and Research Hospital, Samsun University Faculty of Medicine, Samsun, Turkey
| | - Ali Ahiskalioglu
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
- Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, Erzurum, Turkey
| | - Burhan Dost
- Department of Anesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Silvia Manfrin
- UOC Anesthesia and Intensive Care Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Yunus Emre Karapinar
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - Greta Paganini
- UOC Anesthesia and Intensive Care Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Muzeyyen Beldagli
- Department of Anesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Vittoria Luoni
- UOC Anesthesia and Intensive Care Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Busra Burcu Kucuk Ordulu
- Department of Anesthesiology and Reanimation, Samsun Training and Research Hospital, Samsun University Faculty of Medicine, Samsun, Turkey
| | - Annalisa Boscolo
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Paolo Navalesi
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
- UOC Anesthesia and Intensive Care Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
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Cao SJ, Wu WW, Zhang WY, Zhu T. The safety and efficacy of nalbuphine in laparoscopic cholecystectomy: A prospective randomized controlled trial. Asian J Surg 2022; 45:1561-1564. [PMID: 35365389 DOI: 10.1016/j.asjsur.2022.03.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 02/05/2023] Open
Affiliation(s)
- Shuang-Jiao Cao
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, PR China
| | - Wei-Wei Wu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, PR China
| | - Wei-Yi Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, PR China.
| | - Tao Zhu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, PR China.
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Liu L, Xia T, Ji H, Guo Y, Liu J, Du L, Lei D, Han C, Ma T. Sodium Bicarbonate Sub-Diaphragmatic Irrigation Relieves Shoulder Pain After Total Laparoscopic Hysterectomy: A Randomized Controlled Trial. J Pain Res 2021; 14:3615-3622. [PMID: 34880668 DOI: 10.2147/jpr.s338716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/19/2021] [Indexed: 01/07/2023] Open
Abstract
Study Objective To determine whether sub-diaphragmatic irrigation with sodium bicarbonate would relieve post-laparoscopic shoulder pain (PLSP) after total laparoscopic hysterectomy. Design Randomized double-blinded trial. Setting Teaching hospital. Patients Seventy patients undergoing total laparoscopic hysterectomy (TLH) for benign indications. Intervention We randomly allocated patients to intervention or control groups where sodium bicarbonate containing flushing liquid or normal saline was irrigated sub-diaphragm before sewing. Measurement & Main Results The primary outcome was PLSP following surgery measured by a numerical rating scale (NRS) (0 = no pain; 10 = worst pain imaginable). Secondary outcomes were abdominal incisional and visceral pain, analgesic use, and sodium bicarbonate related side effects. The incidence of PLSP in intervention group was significantly lower than that in control group (P < 0.05). Contrarily, incisional and visceral pain was similar in both groups (P = 0.1). The consumption of rescue analgesics in the intervention group was lower than that in the control group. Side effects were comparable in both study groups. Conclusion Sub-diaphragmatic irrigation with sodium bicarbonate could effectively reduce shoulder pain, but not abdominal incisional and visceral pain, in patients undergoing TLH without an increase in side effects. Registration information Clinical trial registry number: http://www.chictr.org.cn/ (ChiCTR2100041765). Registration findings http://www.chictr.org.cn/showproj.aspx?proj=66721 Link to clinical trial page and data repository: http://www.medresman.org.cn/pub/cn/proj/projectshshow.aspx?proj=2992.
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Affiliation(s)
- Li Liu
- Department of Anesthesiology, The Affiliated Yixing Hospital of Jiangsu University, Yixing, Jiangsu, People's Republic of China
| | - Tian Xia
- Department of Gynaecology, The Affiliated Yixing Hospital of Jiangsu University, Yixing, Jiangsu, People's Republic of China
| | - Haiyan Ji
- Department of Anesthesiology, The Affiliated Yixing Hospital of Jiangsu University, Yixing, Jiangsu, People's Republic of China
| | - Yaxin Guo
- Department of Anesthesiology, The Affiliated Yixing Hospital of Jiangsu University, Yixing, Jiangsu, People's Republic of China
| | - Junfeng Liu
- Department of Anesthesiology, The Affiliated Yixing Hospital of Jiangsu University, Yixing, Jiangsu, People's Republic of China
| | - Liping Du
- Department of Anesthesiology, The Affiliated Yixing Hospital of Jiangsu University, Yixing, Jiangsu, People's Republic of China
| | - Daoyun Lei
- Department of Anesthesiology, Zhongda Hospital Southeast University, Nanjing, Jiangsu, People's Republic of China
| | - Chao Han
- Department of Anesthesiology, The Affiliated Yixing Hospital of Jiangsu University, Yixing, Jiangsu, People's Republic of China
| | - Tieliang Ma
- Central Laboratory, The Affiliated Yixing Hospital of Jiangsu University, Yixing, Jiangsu, People's Republic of China
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Ben Rehouma M, Kfoury T, Hamdi L, Bouchouareb M, Soued M, Benhamou D, Mazoit JX. Acute Visceral Pain in Rats: Vagal Nerve Block Compared to Bupivacaine Administered Intramuscularly. Anesth Analg 2021; 133:1311-1320. [PMID: 34347648 DOI: 10.1213/ane.0000000000005697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Visceral and parietal peritoneum layers have different sensory innervations. Most visceral peritoneum sensory information is conveyed via the vagus nerve to the nucleus of the solitary tract (NTS). We already showed in animal models that intramuscular (i.m.) injection of local anesthetics decreases acute somatic and visceral pain and general inflammation induced by aseptic peritonitis. The goal of the study was to compare the effects of parietal block, i.m. bupivacaine, and vagotomy on spinal cord and NTS stimulation induced by a chemical peritonitis. METHODS We induced peritonitis in rats using carrageenan and measured cellular activation in spinal cord and NTS under the following conditions, that is, a parietal nerve block with bupivacaine, a chemical right vagotomy, and i.m. microspheres loaded with bupivacaine. Proto-oncogene c-Fos (c-Fos), cluster of differentiation protein 11b (CD11b), and tumor necrosis factor alpha (TNF-α) expression in cord and NTS were studied. RESULTS c-Fos activation in the cord was inhibited by nerve block 2 hours after peritoneal insult. Vagotomy and i.m. bupivacaine similarly inhibited c-Fos activation in NTS. Forty-eight hours after peritoneal insult, the number of cells expressing CD11b significantly increased in the cord (P = .010). The median difference in the effect of peritonitis compared to control was 30 cells (CI95, 13.5-55). TNF-α colocalized with CD11b. Vagotomy inhibited this microglial activation in the NTS, but not in the cord. This activation was inhibited by i.m. bupivacaine both in cord and in NTS. The median difference in the effect of i.m. bupivacaine added to peritonitis was 29 cells (80% increase) in the cord and 18 cells (75% increase) in the NTS. Our study underlines the role of the vagus nerve in the transmission of an acute visceral pain message and confirmed that systemic bupivacaine prevents noxious stimuli by inhibiting c-Fos and microglia activation. CONCLUSIONS In rats receiving intraperitoneal carrageenan, i.m. bupivacaine similarly inhibited c-Fos and microglial activation both in cord and in the NTS. Vagal block inhibited activation only in the NTS. Our study underlines the role of the vagus nerve in the transmission of an acute visceral pain message and confirmed that systemic bupivacaine prevents noxious stimuli. This emphasizes the effects of systemic local anesthetics on inflammation and visceral pain.
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Affiliation(s)
- Mouna Ben Rehouma
- From the Laboratoire d'Anesthésie, Paris-Saclay University and INSERM U1195 Faculté de Médecine de Bicêtre, Le Kremlin-Bicêtre, France
- Department of Anesthesiology and Intensive Care Medicine, Hôpital Bichat, Hôpitaux Universitaires Paris-Nord, APHP
| | - Toni Kfoury
- From the Laboratoire d'Anesthésie, Paris-Saclay University and INSERM U1195 Faculté de Médecine de Bicêtre, Le Kremlin-Bicêtre, France
- Hôpital Bicêtre, Hôpitaux Universitaires Paris-Saclay, APHP, Le Kremlin Bicêtre Cedex, France
| | - Leila Hamdi
- From the Laboratoire d'Anesthésie, Paris-Saclay University and INSERM U1195 Faculté de Médecine de Bicêtre, Le Kremlin-Bicêtre, France
| | - Meriem Bouchouareb
- From the Laboratoire d'Anesthésie, Paris-Saclay University and INSERM U1195 Faculté de Médecine de Bicêtre, Le Kremlin-Bicêtre, France
| | - Mickael Soued
- From the Laboratoire d'Anesthésie, Paris-Saclay University and INSERM U1195 Faculté de Médecine de Bicêtre, Le Kremlin-Bicêtre, France
- Department of Anesthesiology, Hôpital Antoine Béclère, Hôpitaux Universitaires Paris-Saclay, APHP, Clamart, France
| | - Dan Benhamou
- From the Laboratoire d'Anesthésie, Paris-Saclay University and INSERM U1195 Faculté de Médecine de Bicêtre, Le Kremlin-Bicêtre, France
- Hôpital Bicêtre, Hôpitaux Universitaires Paris-Saclay, APHP, Le Kremlin Bicêtre Cedex, France
| | - Jean Xavier Mazoit
- From the Laboratoire d'Anesthésie, Paris-Saclay University and INSERM U1195 Faculté de Médecine de Bicêtre, Le Kremlin-Bicêtre, France
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Soni S, Parmar K, Charan SM, Sethi S, Naik NB. Peritubal Infiltration of Fentanyl Compared to Dexmedetomidine with Ropivacaine in Percutaneous Nephrolithotomy: A Randomized Comparative Analysis. Anesth Essays Res 2019; 13:1-6. [PMID: 31031471 PMCID: PMC6444944 DOI: 10.4103/aer.aer_1_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Context: Dexmedetomidine has been found as an effective adjuvant in various nerve blocks. Despite several studies on dexmedetomidine with ropivacaine, there is no study on comparing with fentanyl in peritubal infiltration in percutaneous nephrolithotomy (PCNL). Aims: The aim of this study was to compare the effect of the addition of dexmedetomidine or fentanyl in peritubal local anesthetic infiltration on pain scores and analgesic consumption in patients who underwent PCNL. Settings and Design: This was a prospective, randomized, double-blind, tertiary care center-based study. Subjects and Methods: A total of 60 American Society of Anesthesiologists Class I, II, and III patients were selected and randomly divided into two groups: Group RF ropivacaine and fentanyl (n = 30) and Group RD ropivacaine and dexmedetomidine (n = 30). Balanced general anesthesia was given. After completion of the surgery, peritubal infiltration was given at 6 and 12 O’clock positions under fluoroscopic guidance. Postoperative pain was assessed using the visual analog scale and dynamic visual analog scale rating 0–10 for initial 48 h. Postoperative sedation was assessed using five-point sedation score. Time to first rescue analgesic, number of doses of tramadol, and total consumption of tramadol required in 48 h were noted. Statistical Analysis Used: Descriptive data were expressed in mean and standard deviation for between-group comparisons; the Chi-square and Fisher's exact tests were used for categorical variables, whereas t-test and Mann–Whitney U-test were used to compare continuous variables between two groups. Results: Duration of analgesia in group RD (12.87 ± 3.85) is more prolonged than group RF (8.13 ± 3.28) h. Total dose of rescue analgesia required in 48 h in group RF was higher as compared to group RD. Conclusions: Addition of dexmedetomidine to ropivacaine is more effective than fentanyl in terms of prolongation of analgesic efficacy of local anesthetic in peritubal block along with short-lived mild sedation.
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Affiliation(s)
- Sumit Soni
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | | | | | - Sameer Sethi
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Naveen B Naik
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
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Kaushal-Deep SM, Lodhi M, Anees A, Khan S, Khan MA. 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. Postgrad Med J 2019; 95:78-84. [PMID: 31015318 DOI: 10.1136/postgradmedj-2018-135662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 10/30/2018] [Accepted: 04/07/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Pain is the main reason for staying overnight at hospital after an uncomplicated laparoscopic cholecystectomy. OBJECTIVES A randomised prospective study was planned to compare the efficacy of intraincisional and intraperitoneal use of 0.2% ropivacaine so that patients undergoing an uncomplicated laparoscopic cholecystectomy can be discharged as a day case in a cost-effective way. METHODS 191 patients were operated by elective four-port laparoscopic cholecystectomy. They were randomised into three groups after triple blinding according to location of 0.2% ropivacaine use. All patients were given ~23 mL of solution (drug or normal saline depending on the group), 20 mL of which was given at intraperitoneal location and ~1 mL/cm of incision intraincisionally. Pain scores (Visual Analogue Scale (VAS), Numeric Rating Scale (NRS) and Faces Pain Scale-Revised (FPS-R)) were evaluated at 4 and 8 hours postoperatively. Only those patients with a VAS ≤3, NRS ≤3 and FPS-R ≤2, no requirement of rescue analgesia, no shoulder pain, ambulated at least once, passed urine and taking oral sips were offered discharge as a day case. RESULTS 31% of patients in intraperitoneal group (n=62) could be discharged as a day case as compared with 48% in intraincisional group (n=68) (p>0.05) and 89% in combined group (n=61) (p<0.05, with respect to both other groups). CONCLUSION The combined use of intraincisional and intraperitoneal ropivacaine is a cost-effective way of discharging approximately 9 in 10 patients as a day case. This study is unique as this is the first study in which only a local anaesthetic has been used to predict discharges as a day case.
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Affiliation(s)
| | - Mehershree Lodhi
- Anaesthesia, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Afzal Anees
- Surgery, Jawaharlal Nehru Medical College and Hospital, Aligarh, Uttar Pradesh, India
| | - Shehtaj Khan
- Surgery, Jawaharlal Nehru Medical College and Hospital, Aligarh, Uttar Pradesh, India
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