A COMPARATIVE STUDY OF POSTOPERATIVE ANALGESIA FROM INTRAPERITONEAL INSTILLATION OF ROPIVACAINE V/S ROPIVACAINE + FENTANYL IN LAPAROSCOPIC CHOLECYSTECTOMY SURGERIES

2021 ◽  
pp. 59-63
Author(s):  
Vaibhavi j. Hajariwala ◽  
Disha Baxi ◽  
Birva Khara ◽  
Bhumika Pathak
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Adverse Effects ◽  
Normal Saline ◽  
Pain Perception ◽  
P Value ◽  
Chi Square ◽  
Exact Test ◽  
Institutional Ethics ◽  
Post Operative Pain ◽  
Intraperitoneal Instillation

Background and Aim: This study is designed and conducted to compare the efcacy of intra-peritoneal instillation of ropivacaine to that of a combination of ropivacaine and fentanyl in reducing post-operative pain and the side effects of the same. Aim: To compare the effects of intra-peritoneal instillation of ropivacaine to a combination of ropivacaine and fentanyl on postoperative morbidity in terms of: 1. Post-operative pain 2. Post-operative adverse effects Methods and Material: After approval of the Institutional Ethics Committee (IEC) [IEC/HMPCMCE/105/Faculty/12/107/19] and the Clinical Trials Registry of India [CTRI/2020/04/024616], consenting patients were randomized into two groups of 26 participants each. One group was given intraperitoneal instillation with 15ml of ropivacaine 0.75% diluted in normal saline to make a solution of 45ml and other group was given 15ml of 0.75% ropivacaine with fentanyl 50mcg(1ml) diluted in normal saline to make a solution of 45ml, intra-operatively, and post-operative pain perception and occurrence of adverse effects was recorded. Statistical Analysis: Two sample t-test with equal variances, chi-square test and Fisher's exact test. P value<0.05 was considered signicant Results: Group receiving intraperitoneal instillation of plain ropivacaine was found to have signicantly higher VAS scores and VRS scores (p<0.001) and lesser mean time to requirement of rst-dose of analgesic post-operatively (p<0.001), and lesser incidence of bradycardia (p=0.01) Conclusion: Intraperitoneal instillation of combination of ropivacaine and fentanyl is superior to ropivacaine alone for reducing post-operative pain in patients undergoing laparoscopic cholecystectomy surgery.

scholarly journals Comparative Evaluation of Effectiveness of Intravenous Paracetamol and Intravenous Diclofenac as Post-operative Analgesia in Laparoscopic Cholecystectomy

2018 ◽  
Vol 6 (2) ◽  
pp. 6
Author(s):  
Kalpana Kharbuja ◽  
Mahesh Sharma ◽  
Nil Raj Sharma
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Visual Analogue Scale ◽  
Analogue Scale ◽  
P Value ◽  
Anesthesia Induction ◽  
Chi Square ◽  
Rescue Analgesia ◽  
Post Operative Period ◽  
Post Operative Pain ◽  
Intravenous Paracetamol

Introduction: Though the development of minimally invasive surgery  has revolutionized the field of surgery,  post-operative pain is still a significant issue. Unlike in the past, concerns about adverse effects have limited the role of opioids in post-operative pain management. This study aims to compare the effectiveness of intravenous paracetamol and  diclofenac as postoperative analgesia in laparoscopic cholecystectomy. Methods:One hundred and twenty eight patients of American Society of Anesthesiologists (ASA) categories I and II  included in this study  were divided into two groups. Anesthesia induction and maintenance were standardized. The first group received 15mg/kg (maximum 1gm) intravenous paracetamol and the second group received 2mg/kg (maximum 75mg) intravenous diclofenac 30 minutes prior to ending of surgery. A questionnaire was responded by patients and chart was maintained by visual analogue scale. Mann Whitney U test was used to analyze quantitative data and Chi-square test for categorical data. P value <0.05 was considered statistically significant. Results:  Profiles of hemodynamic changes were almost similar in both groups with respect to heart rate and blood pressure. However, paracetamol infusion provided hemodynamic stability in post-operative period. We observed statistically significant differences  in visual analogue scale between the two groups. Most of the patients in paracetamol group had low mean pain scores in post-operative period and provided an extended analgesia compared to diclofenac. No serious postoperative complication was observed in  paracetamol group.   Conclusion: Administration of intravenous paracetamol has better and prolonged analgesic effect  with low mean pain score and less requirement for rescue analgesia compared to diclofenac.

SP1.2.9To Evaluate the Analgesic Efficacy of Intraperitoneal Tramadol Vs Placebo for Post Operative Pain Relief Following Laparoscopic Cholecystectomy, A Double Blind Randomized Control Trial

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Siddhartha Handa ◽  
MS Sangolli ◽  
Sanjay Panchal
Keyword(s):  
Adverse Effect ◽  
Laparoscopic Cholecystectomy ◽  
Pain Relief ◽  
Adverse Effects ◽  
Controlled Trial ◽  
Analgesic Efficacy ◽  
Double Blind ◽  
Institutional Ethics ◽  
Intraperitoneal Instillation ◽  
The Mean

Abstract Aim To study the effectiveness of intraperitoneal instillation of tramadol for postoperative laparoscopic cholecystectomy (LC) pain relief and improve incidence of adverse effect. Methods Double blinded randomized controlled trial over 1 year. The Ethical Clearance was obtained from Institutional Ethics Committee. 60 patients scheduled for LC were enrolled in the study. Patients were randomly assigned into 2 groups using computer generated random numbers. Group T: Received intraperitoneal tramadol 100 mg (diluted in 20 mls distilled water). Group S: Received 20 ml of intraperitoneal normal saline. Pain was assessed using VAS. The assessment was done at 0, 15, 30, 60 minutes, 4, 8, 12, 16 and 24 hours. Incidence of adverse effect were observed. Results In group T, the mean pain scores at all the intervals were significantly low (p &lt; 0.050) except at 24 hours (p = 0.210). Analgesia requirement was significantly high in group S compared to group T immediate post op, 15, 60 minutes, 8 and 12 hours (p &lt; 0.050). The mean requirement of analgesia immediate post op, 15 minutes, 4 and 8 hours was significantly low in group T compared to group S (p &lt; 0.050). 30% patients in group T did not require analgesia at all compared to S (p &lt; 0.001). Incidence of adverse effects at 4 hours was 43% in group S compared to 40% in group T (p &gt; 0.050). Conclusion Intraperitoneal instillation of tramadol in LC has beneficial effect in terms of postoperative pain relief following LC and lower requirement of analgesia. However, the incidence of adverse effects was comparable in both the groups.

scholarly journals Use of Pregabalin as a Pre-Medication for Post-Operative pain in patients undergoing Laparoscopic Cholecystectomy

2019 ◽  
Vol 8 (1) ◽  
pp. 29-33
Author(s):  
Tabish Hussain ◽  
Asifa Anwar Mir ◽  
Jawad Zahir ◽  
Pervaiz Minhas
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
P Value ◽  
Chi Square ◽  
Vas Score ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Operative Evaluation ◽  
Group A ◽  
Group B

Background: Postoperative pain creates complications by increasing circulating level of catecholamines and systemic vascular resistance, thus putting the patients on increased risks of having stroke and myocardial infarction. In addition, it increases hospital stay, causing burden over economic as well as healthcare infrastructure. The aim of this study was to determine the frequency of pain in the postoperative period while using Pregabalin as pre-medication among patients undergoing laparoscopic cholecystectomy.Material and Methods: The randomized control trail was conducted at Department of Anesthesiology, Holy Family hospital, Rawalpindi from 1st Sept 2015 to 28th Feb 2016 over a period of 6 months. A total of 200 patients undergoing laparoscopic cholecystectomy were randomly divided in group A and B by consecutive non-probability lottery method. Group A received 100 mg oral Pregabalin 1 hour before surgery and Group B were not given Pregabalin and were taken as controls. Post-operative pain was measured by visual analog scale (VAS) in terms of pain scores at 4 hours postoperatively after the arrival of patient in the post-anesthesia care unit (PACU). SPSS version 17.0 was used to analyze the data.Results: A total of 200 patients were included in the study. There were 100 patients in each group. Based on the visual analog pain scores, 9 patients were pain free in group A compared with none in group B. Similarly, there were 55 patients in group A, who reported a pain score of 1 whereas no patient in group B had a VAS score of 1. There were 29 patients in group A and only 3 patients in group B with VAS score of 2 (90.6% vs. 9.4%). For VAS score of 3, there were 6 patients in group A and 34 patients from group B (15% vs. 85%). For a VAS score of 4, there were 1 patient in group A and 61 patients in group B (1.6% vs. 98.4%). Two patients in group B experienced a VAS score of 5. All this data was significant with chi square p value of 0.0001.Conclusion: Oral Pregabalin administered prior to laparoscopic cholecystectomy was effective in reducing postoperative pain in the patients. Further studies are needed for post-operative evaluation of side effects, different dosing schedules at different time intervals for both rest and dynamic pain.

scholarly journals Comparison of mean pain scores for the patients with sub hepatic drainage to those without it after elective uncomplicated laparoscopic cholecystectomy

2019 ◽  
Vol 35 (1) ◽  
Author(s):  
Faisal Nadeem ◽  
Muhammad Khan ◽  
Faheem Ullah Naz
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Military Hospital ◽  
P Value ◽  
Chi Square ◽  
Creative Commons ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Chi Square Test ◽  
Drainage Group

Objective: The sub hepatic drain is often placed after laparoscopic cholecystectomy is considered to affect post operative infection, pain and sub hepatic collections. The objective of this study was to compare the degree of postoperative pain in patients with routine drainage with those without it after elective, uncomplicated laparoscopic cholecystectomy. Methods: This randomized control trial (RCT) was done over six months from 9th June 2015 to 8th December 2015 at Military Hospital Rawalpindi. Sample calculated with WHO calculator and consecutive non probability random sampling used to divide 170 patients undergoing laparoscopic cholecystectomy in two groups. One group had routine sub hepatic drain and other didn’t. Degree of postoperative pain was assessed according to VISUAL ANALOGUE SCALE by duty doctor at 24 hours. Data was collected and analyzed applying chi square test and p value was <0.05 considered statistically significant. Results: Our results demonstrated that intensity of post operative pain in routine drainage group is higher as compared to non drainage group after elective, uncomplicated laparoscopic cholecystectomy. Conclusion: Routine placement of sub hepatic drain in elective uncomplicated laparoscopic cholecystectomy should be avoided to reduce post-operative pain. How to cite this:Nadeem F, Khan MR, Naz FU. Comparison of mean pain scores for the patients with sub hepatic drainage to those without it after elective uncomplicated laparoscopic cholecystectomy. Pak J Med Sci. 2019;35(1):226-229. doi: https://doi.org/10.12669/pjms.35.1.224 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Kontribusi Karakteristik Ibu Terhadap kejadian Stunting Pada Anak Usia 24-36 Bulan Di Sleman Yogyakarta

2019 ◽  
Vol 12 (02) ◽  
Author(s):  
Prastiwi Putri Basuki ◽  
Triana Uminingsih
Keyword(s):  
P Value ◽  
Fisher Exact Test ◽  
Chi Square ◽  
Cross Sectional ◽  
Exact Test ◽  
Purposive Sampling

Stunting pada masa balita perlu mendapat perhatian khusus termasuk pada anak usia 24-36 bulan. Usia 24-36 bulan merupakan usia anak yang mengalami perkembangan pesat dalam kemampuan kognitif dan motorik. Banyak faktor yang mempengaruhi terjadinya kejadian stunting pada anak, antara lain karakteristik ibu. Tujuan dari penelitian ini adalah mengetahui kontribusi karakteristik ibu terhadap kejadian stunting pada anak usia 24-36 bulan. Penelitian ini merupakan penelitian observasional analitik dengan pendekatan cross sectional yang dilakukan di Desa Sendang Mulyo Minggir Sleman Yogyakarta. Sampel yang diambil sebanyak 75 anak usia 24-36 bulan dengan teknik purposive sampling. Analisis data  bivariat menggunakan Chi Square dan Fisher Exact Test dan analisis multivariat menggunakan regresi linier. Hasil penelitian menunjukkan bahwa pendidikan ibu (p value=0,000), pengetahuan ibu (p value=0,022) dan pemberian ASI Ekslusif (p value=0,011) yang artinya terdapat hubungan dengan kejadian stunting. Sedangkan status pekerjaan ibu (p value=0,217) tidak signifikan berhubungan dengan kejadian stunting. Berdasarkan analisis multivariat regresi linier menunjukkan hasil bahwa pendidikan ibu, status  pekerjaan ibu, pengetahuan ibu tentang gizi, dan pemberian ASI Ekslusif bersama-sama mempunyai kontribusi terhadap kejadian stunting sebesar 88,2%. Perlu peningkatan program multisektoral dengan melibatkan semua lapisan masyarakat untuk mengurangi kejadian stunting.

Concomitant Traumatic Brain Injury and Hemorrhagic Shock: Outcomes Using the Spanish Trauma ICU Registry (RETRAUCI)

2020 ◽  
pp. 000313482094999
Author(s):  
Mario Chico-Fernández ◽  
Jesús A. Barea-Mendoza ◽  
Jon Pérez-Bárcena ◽  
Iker García-Sáez ◽  
Manuel Quintana-Díaz ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hemorrhagic Shock ◽  
Fresh Frozen Plasma ◽  
Categorical Variables ◽  
P Value ◽  
Trauma Patients ◽  
Chi Square ◽  
Exact Test ◽  
Fresh Frozen

Background To compare the main outcomes of trauma patients with and without traumatic brain injury (TBI), hemorrhagic shock, and the combination of both using data from the Spanish trauma intensive care unit (ICU) registry (RETRAUCI). Methods Patients admitted to the participating ICUs from March 2015 to May 2019 were included in the study. The main outcomes were analyzed according to the presence of TBI, hemorrhagic shock, and/or both. Comparison of groups with quantitative variables was performed using the Kruskal-Wallis test, and differences between groups with categorical variables were compared using the Chi-square test or Fisher’s exact test as appropriate. A P value <.05 was considered significant. Results Overall, 310 patients (3.98%) were presented with TBI and hemorrhagic shock. Patients with TBI and hemorrhagic shock received more red blood cell (RBC) concentrates, fresh frozen plasma (FFP), a higher ratio FFP/RBC, and had a higher incidence of trauma-induced coagulopathy (60%) ( P < .001). These patients had higher mortality ( P < .001). Intracranial hypertension was the leading cause of death (50.4%). Conclusions Concomitant TBI and hemorrhagic shock occur in nearly 4% of trauma ICU patients. These patients required a higher amount of RBC concentrates and FFP and had an increased mortality.

scholarly journals ATIM-06. TREATMENT OF RECURRENT/REFRACTORY (R/R) ANAPLASTIC ASTROCYTOMA (AA, WHO GRADE 3) PATIENTS WITH ANTI-TGFß2 RNA THERAPEUTIC OT-101 VERSUS TEMOZOLOMIDE IS ASSOCIATED WITH IMPROVED OVERALL SURVIVAL

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi2-vi2
Author(s):  
Fatih Uckun ◽  
Sanjive Qazi ◽  
David Nam ◽  
Larn Hwang ◽  
Vuong Trieu
Keyword(s):  
Overall Survival ◽  
Phase 1 ◽  
Single Agent ◽  
Objective Response ◽  
Clinical Results ◽  
P Value ◽  
Convection Enhanced Delivery ◽  
Chi Square ◽  
Who Grade ◽  
Exact Test

Abstract BACKGROUND OT-101 is a first-in-class RNA therapeutic designed to disrupt the immunosuppressive action of TGFß2. During Phase 1 clinical trials, OT-101 induced partial responses in R/R AA patients. We now report our clinical results from a randomized Phase IIB study (NCT00431561) that further evaluated its single agent activity in R/R AA patients in side-by-side comparison with the standard chemotherapy drug temozolomide (TMZ). METHODS OT-101 was administered via high-flow microperfusion with an intratumoral catheter using a convection enhanced delivery (CED) system. 26 AA patients (12: 2.5 mg/cycle; 14: 19.8 mg/cycle) received 7-day cycles of OT-101 every other week via continuous infusion for 4–11 cycles. Response determinations were based on central review of MRI scans by an independent review committee according to standard as well as modified McDonald criteria. 11 patients in the active control arm were treated with TMZ (150–200 mg/m2, 5 days/28-day cycles x up to 6 treatment cycles). Standard statistical methods were applied for the analysis of data. RESULTS 14 of 26 patients (53.8%) treated with 4–11 cycles of OT-101 had either a CR (N=2) or PR (N=12) as their best overall response. The average time until 99% reduction of their tumor volumes ranged from 9.9 to 115.4 (median: 23.7) months. In contrast, only 1 of 10 evaluable patients (10%) treated with TMZ achieved an objective response which was a PR (Fisher’s exact test, 2-tailed, P-value = 0.0002). The median overall survival (OS) was 1154 days (95% CI: 811 - >1743) for the OT-101 group and 590 days (95% CI: 287 - >1137) days for the TMZ group (Log Rank Chi Square = 7.55, P-value = 0.006). CONCLUSION Our results confirm and extend previous studies and provide early evidence that the anti-TGFß2 RNA therapeutic OT-101 is at least as active as TMZ in salvage therapy of R/R AA patients.

scholarly journals Prevalence of microalbuminuria and associated factors among HIV − infected ART naïve patients at Mulago hospital: a cross-sectional study in Uganda

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Thomas Kiggundu ◽  
Robert Kalyesubula ◽  
Irene Andia-Biraro ◽  
Gyaviira Makanga ◽  
Pauline Byakika-Kibwika
Keyword(s):  
Antiretroviral Therapy ◽  
Cross Sectional Study ◽  
Cd4 Count ◽  
P Value ◽  
Mulago Hospital ◽  
Sectional Study ◽  
Chi Square ◽  
Cross Sectional ◽  
Exact Test ◽  
Increased Risk

Abstract Background HIV infection affects multiple organs and the kidney is a common target making renal disease, one of the recognized complications. Microalbuminuria represents an early, important marker of kidney damage in several populations including HIV-infected antiretroviral therapy (ART) naïve patients. Early detection of microalbuminuria is critical to slowing down progression to chronic kidney disease (CKD) in HIV-infected patients, however, the burden of microalbuminuria in HIV-infected antiretroviral therapy (ART) naïve patients in Uganda is unclear. Methods A cross-sectional study was conducted in the Mulago Immune suppression syndrome (ISS) clinic among adult HIV − infected ART naïve outpatients. Data on patient demographics, medical history was collected. Physical examination was performed to assess body mass index (BMI) and hypertension. A single spot morning urine sample from each participant was analysed for microalbuminuria using spectrophotometry and colorimetry. Microalbuminuria was defined by a urine albumin creatinine ratio (UACR) 30-299 mg/g and macroalbuminuria by a UACR > 300 mg/g. To assess the factors associated with microalbuminuria, chi-square, Fisher’s exact test, quantile regression and logistic regression were used. Results A total of 185 adult participants were consecutively enrolled with median age and CD4+ counts of 33(IQR = 28–40) years and 428 (IQR = 145–689) cells/μL respectively. The prevalence of microalbuminuria was 18.9% (95% CI, 14–25%). None of the participants had macroalbuminuria. CD4+ count <350cells/μL was associated with increased risk of microalbuminuria (OR: 0.27, 95% CI: 0.12–0.59), P value = 0.001). Diabetes mellitus, hypertension, smoking, alcohol intake were not found to be significantly associated with microalbuminuria. Conclusion Microalbuminuria was highly prevalent in adult HIV − infected ART naive patients especially those with low CD4+ count. There is need to study the effect of ART on microalbuminuria in adult HIV − infected patients.

Circulating tumor DNA (ctDNA) landscape in metastatic castrate-resistant prostate cancer patients with germline alterations.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 200-200
Author(s):  
Marcus W. Moses ◽  
Peter Steinwald ◽  
Ellen Jaeger ◽  
Whitley Hatton ◽  
Patrick Cotogno ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
San Francisco ◽  
Splice Variants ◽  
Circulating Tumor Dna ◽  
P Value ◽  
Fisher Exact Test ◽  
Chi Square ◽  
Exact Test ◽  
Viable Approach ◽  
Tumor Dna

200 Background: Circulating tumor-DNA (ctDNA) in mCRPC patients (pts) provides a viable approach for examining the genetic landscape of prostate cancer. In this follow-up, we report ctDNA variants in germline tested mCRPC pts. Methods: ctDNA alterations in 73 genes were detected using Guardant360 (G360) assays. Alteration types assessed were missense, frameshift, insertions, splice variants, truncations, amplifications (amp), deletions, and other. Pts included in the analysis received germline genetic testing (Invitae Corporation, San Francisco, CA) and ctDNA assays at various treatment timepoints. Statistical analyses were performed using chi-square and fisher exact test with p-value <0.05 for significance. Results: Germline and ctDNA testing was completed in 270 mCRPC pts. 13% (35/270) of pts had pathogenic germline alterations. Germline alterations detected were BRCA2 (43%, n=15), ATM (8.5%, n=3), CHEK2 (8.5%, n=3), and BRCA1 (6%, n=2). Of the 673 alterations detected in G360 assays, TP53 (25%, n=167) and AR (17%, n=117) were most commonly observed. ctDNA alteration breakdown for germline negative/positive pts is summarized in Tables A/B. Germline negative pts had more AR alterations compared to germline positive (p = 0.023). Also, germline negative pts presented with more amps (p < 0.001) and germline positive pts with more frameshift alterations (p = 0.005). The association of ctDNA alteration to clinical outcomes in germline positive/negative pts was also assessed and is ongoing. Conclusions: Pts with germline positive alterations had few somatic AR alterations and higher frequency of deleterious mutation in comparison to their germline negative counterparts.[Table: see text][Table: see text]

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