Background: Dexmedetomidine now has become one of the frequently used drugs as part of a multimodal analgesic regimen to provide improved pain control at all perioperative stages for laparoscopic surgeries. Aims and Objectives: In this prospective, double-blind, randomized, and control trial, we compared the postoperative analgesic efficacy of intravenous (IV) dexmedetomidine and intraperitoneal (IP) dexmedetomidine in laparoscopic cholecystectomy. Materials and Methods: Sixty patients of the American Society of Anesthesiologists Grade I and II undergoing laparoscopic cholecystectomy were allocated into two groups. The patients in Group-IV had received 30 ml of 0.5 μg/kg Dexmedetomidine infusion intravenously plus 40 ml of Ropivacaine (30 mL of 0.5% Ropivacaine and 10 ml NS) intraperitoneally and in Group-IP received 30 ml NS intravenously and 40 ml of Ropivacaine plus Dexmedetomidine (30 mL of 0.5% Ropivacaine and 0.5 μg/kg Dexmedetomidine diluted in 10 ml NS) intraperitoneally after removal of the gallbladder. Patients were assessed during the first 24 h postoperatively for time to the first requirement of analgesia, total analgesic consumption, sedation, hemodynamics, side effects, and patient satisfaction. Results: Time to first request of analgesia (min) was longer (216.46±42.19 vs. 108.03±48.77) and total analgesic consumption (mg) was lower (92.50±32.26 vs 115.0±38.056) in Group-IV than in Group-IP. A significant difference was observed in visual analogue score in Group-IV at 1 h, 2 h, 4 h postoperatively and in the patient satisfaction score (P=0.024) in comparison to Group-IP. Conclusion: The postoperative analgesic effects and patient satisfaction, of low dose IV Dexmedetomidine plus IP instillation of Ropivacaine, are superior to low dose IP Dexmedetomidine added to Ropivacaine.
Background: Cholelithiasis in children was reported about three centuries back and remained relatively uncommon in the past but now it is evolving and ever-increasing in frequency. We aimed to study the clinical presentation, predisposing factors, and treatment outcome of cholelithiasis in children in western Odisha. Methodology: The present prospective study was conducted on 38 patients less than 18 years old, with ultrasound proved cholelithiasis. Data were reviewed concerning patient demographic profile, clinical history including risk factors, imaging studies, operative techniques, postoperative complications, and treatment outcome. Results: 38 children (14 boys and 24 girls) with cholelithiasis were evaluated and treated during the study period and the mean age was 14.25±3.01 years (range 5 to 18 years). 44.73% of children (n = 17) belonged to rural backgrounds and the rest to urban setups, and 23(60.52%) of patients belonged to the Hindu religion. In 63.15% of patients, no risk factor could be traced. 73.68% of children had multiple gallstones. 28(73.68%) patients underwent laparoscopic cholecystectomy. The average duration of hospital stay was 4.42 days. No major intraoperative or postoperative complications could be detected. Conclusions: In this region of the country most of the children had no risk factors identified for cholelithiasis. Girls with middle socioeconomic status and urban areas belonging to the Hindu religion were more affected by the disease. In view of the high incidence of serious complications of gallstones in children and because of longer life expectancy we also recommend that expectant management of gallstones may not be safe and hence laparoscopic cholecystectomy must be done even in asymptomatic cholelithiasis.
Background and Aim: The surgical repair of inguinal hernia is one of the most common general surgery procedures performed. The present study was undertaken to compare intra operative and postoperative outcomes of Lichtenstein tension free mesh hernioplasty under local anaesthesia as compared to spinal anaesthesia. Materials and Methods: In this longitudinal study 100 patients aged between 20-80 years, posted for elective mesh hernioplasty were enrolled and divided into two groups. Group-L(n=50) hernioplasty done under local anaesthesia and Group-S(n=50) hernioplasty done under spinal anaesthesia. Patients were assessed for intraoperative comfort or pain felt during surgery, duration of surgery, postoperative pain score, postoperative analgesic doses required, duration of hospital stay and patient satisfaction. Results: Intraoperative pain was comparable in both groups(p=0.695). There was statistically significant difference observed in duration of surgery(p=0.001), postoperative pain at 6hrs(p=0.001), 24hrs(p=0.009) and 48hrs(p=0.047). The mean duration of hospital stay was 2.12 ± 0.172 days in Group-L and 3.9 ± 1.1days in Group-S (p=0.001). The total incidence of postoperative complications seen in Group-L and in Group-S were 6% and 32% respectively which was statistically significant (p-0.001). In Group-L 84% of cases responded ‘satisfactory’ and in Group-S 80% responded ‘satisfactory’ at 6 weeks follow up, which was statistically not significant. Conclusion: Lichtenstein tension free mesh hernioplasty under local anaesthesia can be used as a safer alternative to spinal anaesthesia with advantages of less postoperative pain and postoperative complications in uncomplicated inguinal hernia.
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