The main reason for using multimodal analgesia techniques is to avoid possible side effects by limiting the utilisation of commonly used opioids to provide postoperative analgesia. 9 So far many studies have been done using intraperitoneal or intraincisional local anaesthetic infiltration, but the results have been conflicting. [10][11][12][13][14] The aim of our study was to compare the ABSTRACT Background: The aim of this study was to compare the efficacy of infiltration of local anaesthetic bupivacaine at incision site (port site) and intraperitoneally on postoperative pain in patients undergoing laparoscopic cholecystectomy. Methods: This was a randomized controlled study carried out on patients undergoing laparoscopic cholecystectomy. The patients were divided into three groups of 60 patients each. Group 1 was the control group which did not receive either intraincisional or intraperitoneal bupivacaine. Group 2 received intraincisional bupivacaine 0.25% 20 ml, while group 3 received 20 ml solution of bupivacaine 0.25% 20 ml intraperitoneally. Postoperative pain was recorded for 24 hours post-operatively. Results: The incidence of abdominal pain was significantly lower in the group which received intraincisional bupivacaine upto 12 hours postoperatively. Right shoulder pain was low in group receiving intraperitoneal bupivacaine as compared to group 2, but it was not statistically significant. Conclusions: Intraincisional (port site) infiltration of bupivacaine is more effective than intraperitoneal infiltration for postoperative pain relief after laparoscopic cholecystectomy. It is easier to apply and there is less requirement of postoperative analgesics.
Background:In patients undergoing laparoscopic surgeries, postoperative nausea and vomiting (PONV) is a serious concern. With an incidence of 46%–72%, PONV hampers the postoperative recovery in spite of the availability of many antiemetic drugs. The purpose of this study was to prospectively evaluate the efficacy of palonosetron and granisetron for the prevention of PONV in patients undergoing laparoscopic abdominal surgery.Aims:The aim of this study was to evaluate and compare the efficacy of palonosetron and granisetron in preventing PONV and to compare the duration of action and side effects in patients undergoing laparoscopic abdominal surgery under general anesthesia.Settings and Design:Eighty patients who were comparable in all aspects were considered for this study. After their consent, they participated in this prospective, randomized, double-blinded, comparative study.Materials and Methods:In this observational study, 80 patients of either gender who were undergoing laparoscopic abdominal surgery under general anesthesia were enrolled in the study. Based on computer randomization, these patients were divided equally into two groups of 40 patients each in double-blinded manner. The treatments were given intravenously 5 min before induction of anesthesia. The episodes of PONV, severity of nausea/vomiting, and side effects were observed during the first 48 h after surgery.Statistical Tests:At the end of study, results were compiled and SPSS® statistical package version 18.0 (SPSS Inc., Chicago, IL, USA). Two independent samples t-test was used for quantitative data, and Chi-square or Fisher's exact test was used for qualitative data. P < 0.05 was considered significant.Results:The incidence of PONV during 0–2 h in the postoperative period was 15% with palonosetron and 27.5% with granisetron; the incidence during 2–24 h postoperatively was 20% with palonosetron and 30% with granisetron. Both palonosetron and granisetron had comparable effectiveness as antiemetic during the early postoperative periods (0–24 h). During 24–48 h, the incidence was 17.5% and 37.5%, respectively (P = 0.04). Safety profile was similar in both the groups (P = 0.6).Conclusion:There were no significant differences in the overall incidence of PONV and complete responders for palonosetron and granisetron group in the early recovery period. However, due to its prolonged duration of action, palonosetron was more effective than granisetron for long-term prevention of PONV after laparoscopic abdominal surgery.
Background: During caesarean section hypotension due to spinal block is secondary to the sympathetic blockade and aorto-caval compression by the uterus. It can have important consequences for the mother and may affect neonatal outcome. The present study was aimed to compare intravenous bolus doses of phenylephrine and ephedrine to treat maternal hypotension during spinal block for elective caesarean section.Methods: After fulfilling the inclusion criteria, 100 parturient were randomly allocated into two groups of fifty each. For spinal anesthesia lumber puncture was done and 12.5mg, 0.5% hyperbaric bupivacaine was given intra-thecally. In this observational study, patients who developed hypotension under spinal anesthesia were selected for the study. According to their group, patients received either ephedrine 6mg (Group E) or phenylephrine 75µg (Group P) as vasopressor. During the study, number of vasopressor boluses, hemodynamic response and time taken to recover from hypotension was noted.Results: Ephedrine and phenylephrine were used in the mean doses of 6.72±1.97mg and 91.5±31.38µg respectively. In 88% parturient single bolus dose of ephedrine was effective in treating hypotension while phenylephrine was effective in 78% parturient. There was no significant difference observed in total number of boluses used. No significant difference was seen in mean systolic blood pressure, mean diastolic blood pressure and mean arterial pressure over a given period of time in Group E and Group P. Mean systolic BP was less than 20% when compared to baseline in both the groups at different time intervals. In Group P the mean heart rate was significantly lower as compared to the Group E (p<0.05).Conclusions: Intravenous phenylephrine and ephedrine are both similar in performance in treating hypotension after spinal anesthesia for elective caesarean section and the hypotensive control offered is comparable.
Background: During elective caesarean sections, post-spinal hypotension is a common problem. Prevention of this complication by sympathomimetic agents is of potential clinical significance. The objective of this study was to compare and evaluate the effects of ephedrine and phenylephrine on the fetal outcome when used in the treatment of maternal hypotension during spinal block in elective caesarean section.Methods: After fulfilling the inclusion criteria, hundred patients were enrolled in this study and were randomly allocated into two groups of fifty each. According to their group, patients received either ephedrine 6 mg (group E) or phenylephrine 75µg (group P) as vasopressor. For spinal anaesthesia lumber puncture was done in sitting position and 12.5mg, 0.5% hyperbaric bupivacaine was given intra-thecally to every patient. Throughout surgery, maternal and neonatal complications were controlled and recorded. During the study, Apgar scores on the 1st and 5th minutes, and blood gases of the umbilical cord blood were evaluated.Results: Ephedrine and phenylephrine were used in the mean doses of 6.72±1.97mg and 91.5±31.38µg respectively. There was no significant difference observed in total number of boluses used in treating post-spinal hypotension. The difference in the first- and fifth-minute Apgar scores was statistically insignificant between the group E and group P. There was a statistically significant difference observed in SaO2 and base excess in arterial gas sample between two studied groups. Similarly, a significant difference was observed in PCO2 of umbilical venous sample between two studied groups. However, none of the neonates had the true fetal acidosis.Conclusions: Intravenous phenylephrine 75µg and ephedrine 6 mg offer a comparable hypotensive control without any significant complication for mother or her fetus in elective caesarean section.
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