Postlaparoscopic shoulder pain (PLSP) frequently follows laparoscopic surgery. In this placebo-controlled study, we evaluated the efficacy of two perioperative doses of pregabalin 300 mg 12 h apart for preventing and attenuating PLSP after laparoscopic cholecystectomy. The frequency and severity of PLSP, need for postoperative rescue analgesia, and side effect profiles were assessed for 48 h postoperatively. In both groups, the overall incidence of PLSP did not differ significantly, and the pain score for PLSP, time to first rescue analgesia, and cumulative ketorolac consumption were similar at each timepoint. However, the 2-h postoperative incidence of oversedation was higher with pregabalin.

No abstract

Liver recipients who have antibodies to hepatitis B core antigen (anti-HBc) or received an anti-HBc positive liver graft are at risk of acquiring de novo hepatitis B infection so a life long prophylaxis is required. A post-transplant vaccination against hepatitis B virus (HBV) can offer a better alternative than either hepatitis B hyperimmune globulin (HBIG) or lamivudine. This study investigated the course of anti-HBs titer after vaccination and analyzed the factors that influence the response. Between October 1999 and February 2003, 37 pediatric patients were given a post-transplant vaccination when an anti-HBc positive graft was used, the recipient was anti-HBc positive, or when anti-HBs titer was below 20 IU/L irrespective of the serological status. Thirty-three patients responded to the vaccine and did not require further HBIG injections at a mean follow up of 33.6 months. Fifteen patients were good responder and only needed a single set of vaccines, and 18 were poor responder needing additional boosters. Two patients developed de novo hepatitis B infection and two required additional HBIG injections. Preoperative severity of liver disease, serological status of HBV of recipient or donor, use of HBIG or pulse steroid therapy, type of vaccines, and dose or time interval between doses had no influence on response rate. Recipients with a high preoperative anti-HB titer, small graft-recipient weight ratio (GRWR), greater catch up growth, heavier body weight, lower tacrolimus level at the time of vaccination, and longer time interval between transplant or steroid medication and vaccination yielded good response. If well tailored, post-transplant vaccination can be effective and offer patients prophylaxis against de novo hepatitis B infection for a prolonged period of time.

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D onor organ shortages occasionally mandate the use of hepatic allografts from antibody to hepatitis B core antigen (anti-HBc) (ϩ) donors. The transplantation of anti-HBc (ϩ) livers carries a 25% to 95% risk of transmitting hepatitis B virus (HBV) to recipients, 1-6 although some of these studies showed lower rates of HBV infection in recipients who are anti-HBc/ anti-HBs (antibody to hepatitis B surface antigen) positive. 2,3,5,6 Several reports have recommended that some forms of prophylaxis should be undertaken to prevent de novo hepatitis B infection in recipients who received a graft from anti-HBc (ϩ) donors. 1,7-9 Hepatitis B immunoglobulin (HBIG) and/or lamivudine have been used for prophylaxis, but their life-long administration presents problems, such as a mutant strain emergence, high cost, and several side effects. Thus, active immunization is a better strategy than HBIG or lamivudine, if it is effective. Reports issued to date on the active immunization of patients waiting for liver transplantation [10][11][12] and who have undergone liver transplantation have not been satisfactory. 13,14 A poor response rate with vaccination and rapid decline in serum hepatitis B surface antibody (HBsAb) titer have been reported. 14 Recently, good results have been reported for the active immunization of selected patients after liver transplantation. 15