Ultrasonography in the evaluation of hemoperitoneum in war casualties

The aim of this study was to evaluate the sensitivity, specificity, accuracy, and positive and negative predictive values of emergent ultrasound examination in the detection of hemoperitoneum among war casualties, and to compare the results of this method in a specific war situation and civil conditions. Ninety-four wounded individuals with suspected blunt or penetrating abdominal trauma were treated at a level I war hospital (group W), and 242 civilians with multiple injuries with suspected blunt abdominal trauma were evaluated at the emergency center of a university hospital (group C). All examinations were performed in less than 5 minutes with a portable ultrasonographic scanner, and typical points were scanned (Morison's pouch, Douglas and perisplenic spaces, paracolic gutter). In group W, hemoperitoneum was identified correctly in 19 patients, with three false-negative and no false-positive findings, whereas group C presented 98 true-positive results, 13 false-negative results, and again no false-positive results. We observed that ultrasonography in specific war conditions showed sensitivity of 86%, specificity of 100%, accuracy as high as 97%, positive predictive value of 100%, and negative predictive value of 96%, whereas in civil conditions the corresponding values were 88%, 100%, 95%, 100%, and 91%, respectively. The sensitivity, specificity, accuracy, and positive and negative predictive values of emergent ultrasound examination in the diagnosis of hemoperitoneum are approximately equal in war and civil conditions.

Intraperitoneal bupivacaine for analgesia after laparoscopic cholecystectomy

BACKGROUND

The effects of intraperitoneal administration of bupivacaine on pain after laparoscopic cholecystectomy were studied in a prospective, double-blind, randomised trial.

METHODS

Eighty ASA 1 and 2 patients were randomly assigned to one of two groups. Immediately after pneumoperitoneum was obtained patients in group 1 were given 15 ml of 0.5% bupivacaine injected under direct vision into the hepato-diaphragmatic space, near and above the hepato-duodenal ligament and above the gallbladder. At the end of operation another 15 ml of bupivacaine was injected. Patients in group 2 were given 15 ml of 0.9% saline solution in a similar fashion. Postoperative pain was assessed using a visual analogue scale (VAS 100 mm) at 0.5, 4, 8, 12 and 24 h after surgery. Analgesic consumption was also recorded.

RESULTS

Patients' data were similar in the two groups. Pain was more intense in the saline group at each time point. Significant differences between the groups were present for up to 8 h. Analgesic consumption was significantly lower in the bupivacaine group. No side-effects occurred.

CONCLUSION

We conclude that reducing pain with intraperitoneal bupivacaine is effective, easy to administer, and without side-effects.