Evaluation of the effect of intra-operative intravenous fluid on post-operative pain and pulmonary function: a randomized trial comparing 10 and 30 ml kg(-1) of crystalloid

Intraoperative fluid management: Past and future, where is the evidence?

Currently, there is no consensus about the optimum intraoperative fluid therapy strategy. There is growing body of evidence supports the beneficial effects of adopting “Goal-directed therapy” over either the “liberal” or “restrictive” fluid therapy strategies. In this narrative review, we have presented the evidence to support the optimum strategy for intraoperative therapy. In conclusion, whatever the intravenous fluid replacement strategy used, the anesthesiologist must be prepared to adjust the composition and rate of the fluids administered to provide sufficient intravascular fluid volume for adequate perfusion of vital organs without overwhelming the glycocalyx function with fluid overloads.

The immediate effects of spinal thoracic manipulation on respiratory functions

[Purpose] The purpose of this study was to investigate the effects of thoracic spinal manipulation therapy on respiratory function including forced vital capacity and forced expiratory volume in one second in young healthy individuals. [Subjects and Methods] Thirty young healthy subjects recruited from a local university participated in this study. Subjects were randomly allocated into an experimental group (n=15) and a control group (n=15). The experimental group received thoracic spinal manipulation and the control group received placebo thoracic spinal manipulation. Respiratory function tests, including forced vital capacity and forced expiratory volume in one second, were measured before and after intervention. [Results] The values for both tests were significantly higher in the experimental group. The control group showed no changes after the intervention. Differences in pre- and post-intervention values for both tests were significantly different between the 2 groups. [Conclusion] Spinal manipulation therapy applied to the thoracic region improved respiratory function test results of participants in this study.

The effect of peritoneal gas drain on postoperative pain in benign gynecologic laparoscopic surgery: a double-blinded randomized controlled trial

OBJECTIVES

To compare the effect of peritoneal gas drain on postoperative pain in benign gynecologic laparoscopic surgery and the amount of postoperative analgesic dosage.

METHODS

The trial included 45 females who had undergone operations during the period December 2014 to October 2015. The patients were block randomized based on operating time (<2 and ≥2 hours). The intervention group (n=23) was treated with postoperative intraperitoneal gas drain and the control group (n=22) was not. The mean difference in scores for shoulder, epigastric, suprapubic, and overall pain at 6, 24, 48 hours postoperatively were statistically evaluated using mixed-effect restricted maximum likelihood regression. The differences in the analgesic drug usage between the groups were also analyzed using a Student's t-test. The data were divided and analyzed to two subgroups based on operating time (<2 hours, n=20; and $2 hours, n=25).

RESULTS

The intervention had significantly lower overall pain than the control group, with a mean difference and 95% confidence interval at 6, 24, and 48 hours of 2.59 (1.49-3.69), 2.23 (1.13-3.34), and 1.48 (0.3-2.58), respectively. Correspondingly, analgesic drug dosage was significantly lower in the intervention group (3.52±1.47 mg vs 5.72±2.43 mg, P<0.001). The three largest mean differences in patients with operating times of ≥2 hours were in overall pain, suprapubic pain at 6 hours, and shoulder pain at 24 hours at 3.27 (1.14-5.39), 3.20 (1.11-5.26), and 3.13 (1.00-5.24), respectively. These were greater than the three largest mean differences in the group with operating times of <2 hours, which were 2.81 (1.31-4.29), 2.63 (0.51-4.73), and 2.02 (0.68-3.36). The greatest analgesic drug requirement was in the control group with a longer operative time.

CONCLUSION

The use of intraperitoneal gas drain was shown to reduce overall postoperative pain in benign gynecologic laparoscopic surgery. The effects were higher in patients who had experienced longer operating times.