Clinical trial to assess role of ketamine in post operative analgesia after laparoscopic cholecystectomy

2021 ◽  
Vol 23 (05) ◽  
pp. 421-432
Author(s):  
Dr. Mohammad Kheiri Mahmod ◽  
◽  
Dr. Bashar Naser Hussein ◽  
Dr. Ammar Hamid Hanoosh ◽  
◽  
...  
Keyword(s):  
Clinical Trial ◽  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Analgesic Effect ◽  
Analgesic Requirement ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: The physiological consequences of post-operative pain including Stress response to surgery, Respiratory complications, cardiovascular complications, Thromboembolic complications, Gastrointestinal complications, Musculoskeletal complications and Psychological complications, all of which could delay or impair postoperative recovery and increase the economic cost of surgery as a result of the longer period of hospitalization. Inadequate post-operative pain control may also lead to the development of chronic pain after surgery .Aim of This study: is to evaluate the preemptive analgesic effect of intravenous ketamine in laparoscopic cholecystectomy. Patients and Methods: double blinded randomized clinical trial conducted at Al-Yarmouk teaching hospital, over a period of one year from March 2013 to March 2014 on a total of 120 adult patients scheduled for elective laparoscopic cholecystectomy, Patients were divided in to three groups of 40 patients each, the study drug administered intravenously during induction. Groups A and B received ketamine in a dose of 1 and 0.5 mg/kg, respectively, whereas group C received isotonic saline. The degree of pain at rest and deep breathing postoperatively were estimated using VAS, time of first analgesic dose, total opioid consumption, nausea, vomiting and hallucination were recorded for 24 h postoperatively. Results: postoperative pain scores were significantly low in group A when compared with the other groups at most times in the first 24 hours. Highest pain score was in group C at 0 h. Postoperative analgesic consumption was minimum in group A then group B and highest in group C. There was little significant difference in the pain scores between groups B and C. Group A had a significantly higher blood MAP than group B at 0, 0.5 and 1 h. 7.5% incidence of hallucinations were in group A. Conclusion: According to this study we conclude that preemptive ketamine in a dose of 1 mg/kg has a definitive role in reducing postoperative pain and analgesic requirement in patients undergoing laparoscopic cholecystectomy. A low dose of 0.5 mg/kg had little significant in preemptive analgesic effect and in reducing analgesic requirement.

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 The Effect of Pneumoperitoneum-induced Hypertension During Laparoscopic Cholecystectomy Under General Anesthesia on Postoperative Pain: A Randomized Clinical Trial

2022 ◽  
Vol 11 (6) ◽  
Author(s):  
Alireza Pournajafian ◽  
Ali Khatibi ◽  
Behrooz Zaman ◽  
Amir Pourabbasi
Keyword(s):  
Blood Pressure ◽  
Clinical Trial ◽  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
General Anesthesia ◽  
Randomized Clinical Trial ◽  
Pain Scores ◽  
Group A ◽  
Elective Laparoscopic Cholecystectomy ◽  
Group B

Background: Acute postoperative pain is a significant cause of morbidities. This study aimed to evaluate the effect of intraoperative blood pressure during laparoscopic cholecystectomy under general anesthesia on postoperative pain in patients without underlying disorders. Methods: In this randomized clinical trial, 72 patients undergoing general anesthesia for elective laparoscopic cholecystectomy were randomly assigned into two groups: Group A with higher than baseline preoperative blood pressure (MAP allowed to increase up to 20% higher than baseline MAP by inducing pneumoperitoneum) and group B with normal to low blood pressure (MAP deliberately controlled at a tight limit from normal baseline MAP values to 20% less than baseline by titrating TNG infusion). The Visual Analog Scale (VAS) after 2, 8, 12, and 24 hours of surgery, and the total dose of meperidine used to manage postoperative pain were recorded and compared between the two groups. Results: The pain scores in group A were significantly lower than group B (P = 0.001). The postoperative analgesia request time was different between the two groups (P = 0.53). During the first 24 hours, the total meperidine consumption dose in group A was significantly lower than in group B (P = 0.001). Conclusions: High intraoperative blood pressure may affect the postoperative pain after laparoscopic cholecystectomy and lead to less postoperative pain score and analgesic requirements.

Role of a modified epigastric port in reducing post operative pain and causing early ambulation in a patient undergoing laparoscopic cholecystectomy as compared to a standard four port procedure, a randomized controlled study

2020 ◽  
Vol 7 (12) ◽  
pp. 3986
Author(s):  
Arijit Roy ◽  
Pramatha Nath Datta ◽  
Kushankur Guha
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Recovery ◽  
Controlled Study ◽  
Post Operative Pain ◽  
Quality Life ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
To Receive ◽  
Better Than

Background: Standard four port laparoscopic cholecystectomy is the gold standard in the treatment of gall stones. Modified epigastric port laparoscopic cholecystectomy may be considered an alternative, as this procedure maintains the advantages of four ports and does not require any special set of instruments. In this study we aimed to see whether this procedure is comparable to the standard four port laparoscopic cholecystectomy based on the primary objectives of postoperative pain score, degree of ambulation, time to return to normal activities.Methods: Consecutive patients due to undergo laparoscopic cholecystectomy, meeting all the predefined criteria were recruited into the study. The group A was assigned to receive intervention in the form of modified epigastric port laparoscopic cholecystectomy. The group B was assigned to receive intervention in the form of standard four port laparoscopic cholecystectomy. Patients in group A were compared with patients in group B based on multiple pre-defined parameters.Results: Pain scores were significantly better in group A. Degree of ambulation at was significantly better in group A. In respect to the time to resumption of normal activities there was no significant difference between the two groups. When comparing the quality life at 1 month following surgery with SF-36 health survey, the patients in group A did better than patients in group B with respect to the six scales. Conclusions: Modified epigastric port laparoscopic cholecystectomy appears to be significantly better than the standard four port cholecystectomy in terms of postoperative recovery.

scholarly journals Comparison of Pre-emptive Use of Diclofenac, Ketorolac and Tramadol for Post-operative Pain in Laparoscopic Cholecystectomy

2009 ◽  
Vol 20 (1) ◽  
pp. 24-29 ◽  
Author(s):  
Md Rafiqul Hasan Khan ◽  
Md Zohirul Islam ◽  
Md Sazzad Hossain ◽  
Lutful Aziz ◽  
SN Samad Choudhury
Keyword(s):  
Blood Pressure ◽  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Analgesic Efficacy ◽  
Prospective Clinical Study ◽  
The Poor ◽  
Post Operative Pain ◽  
Group A ◽  
Group B ◽  
Better Than

Under treatment of postoperative pain has been the topic of several recent editorials. The prevention, recognition, and management of postoperative pain in adults, as well as in children, have been receiving a great deal of interest. The poor outcome obtained with current regimens is primarily due to the inadequacies of drug administration techniques rather than the qualities of opioids themselves. In this prospective study comparison of preemptive use of diclofenac, ketorolac and tramadol was done for postoperative pain in laparoscopic cholecystectomy. 60 patients were divided into three groups. Group A received injection Diclofenac (3mg/kg) 75mg maximum at a time. Group B received injection Ketorolac (30 mg). And group C patients received injection Tramadol (100 mg). All drugs were given intravenous half an hour before induction. Analgesic efficacy was measured in VAS scale. In addition pulse, systolic blood pressure, diastolic blood pressure, mean blood pressure, total pethidine requirement and time of first pethidine requirement were recorded Patients received an increment of 10-20 mg of pethidine when pain score was 3-4. In this study, total pethidine consumption in group A is 56.5±5.14, in group B is 46.75±4.65 and in group C is 49±5.42. It shows that group B and group C have same analgesic effectiveness and which is better than group A. On the basis of present prospective clinical study postoperative pain can be managed by preemptive use of diclofenac, ketorolac and tramadol. The analgesic efficacy of ketorolac and tramadol is same and better than diclofenac. Key Words: Pre-emptive analgesia, Laparoscopic cholecystectomy. Journal of BSA, Vol. 20, No. 1, January 2007 p.24-29

scholarly journals Effects of Gabapentin on Postoperative Pain and Total Analgesic Requirement After Laparoscopic Cholecystectomy

2019 ◽  
Vol 12 (2) ◽  
pp. 925-929
Author(s):  
Zaffar Abbas ◽  
Amina Bashir ◽  
Zaffar Abbas
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Placebo Group ◽  
Postoperative Pain ◽  
Visual Analogue Scale ◽  
Analogue Scale ◽  
Analgesic Requirement ◽  
Matching Placebo ◽  
Pain Scores ◽  
Group A ◽  
To Receive

The aim of this study is to determine the effect of preoperative use of gabapentin on postoperative pain in patients undergoing laparoscopic cholecystectomy. Sixty adult patients listed for laparoscopic cholecystectomy were randomly allocated to two groups of 30 each to receive gabapentin 600 mg p.o. or a matching placebo 2 hours before surgery. Postoperative pain was monitored using 100 mm visual analogue scale (0 for no pain and 100 for worst imaginable pain) at 1, 2, 6, 12 and 24 hours. Diclofenac 75 mg IM was used as rescue analgesic and total analgesic requirement (mg/24hr) in first 24 hours following surgery was recorded. Postoperative pain scores and total analgesic requirement was significantly less in gabapentin group compared to placebo group. A single 600 mg dose of gabapentin given preoperatively decreased postoperative pain and total analgesic requirement following laparoscopic cholecystectomy. Preemptive use of gabapentin can be used to treat postoperative pain caused by laparoscopic cholecystectomy.

scholarly journals Comparison of intraincisional and intraperitoneal infiltration of local anaesthetic in laparoscopic cholecystectomy to control early postoperative pain.

2021 ◽  
Vol 28 (02) ◽  
pp. 192-196
Author(s):  
Nadia Bano ◽  
Nazim Hayat ◽  
Saira Saleem ◽  
Farhan Javaid ◽  
Ayesha Rehman ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Local Anaesthetic ◽  
Early Postoperative Period ◽  
P Value ◽  
Analgesic Requirement ◽  
Rescue Analgesia ◽  
Group A ◽  
Group B

Objective: To compare the effects of intraincisional and intraperitoneal infiltration of local anaesthetic to relieve early postoperative pain in laparoscopic cholecystectomy. Study Design: Randomized Control Trial. Setting: Department of Anaesthesia and Surgery, Madinah Teaching Hospital Faisalabad. Period: July 2017 to March 2018. Material & Methods: A sample of 100 patients with American Society of Anaesthesiologists Physical status (ASA) I and II, undergoing laparoscopic cholecystectomy were selected using simple random sampling technique. Patients were randomly assigned into groups A and B. Group A patients received intraperitoneal infiltration of 20 ml solution of 0.25% bupivacaine and group B patients received intraincisional infiltration of 20 ml solution of 0.25% bupivacaine. Results:  Demographic characteristics were not significantly different in both groups. Our study showed that Group A patients had better pain relief as compared to group B patients. Visual analogue score (VAS) for pain relief at 0, 3,6,12 and 24 hours was statistically different in both groups. The requirement of rescue analgesia between group A and B was found to be12% and 38% which is statically significant (p value 0.003). Conclusion: intraperitoneal infiltration of Bupivacaine offers better postoperative pain relief after laparoscopic cholecystectomy and is associated with less analgesic requirement in early postoperative period.

scholarly journals Intraperitoneal analgesia to reduce pain after laparoscopic hysterectomy

2017 ◽  
Vol 6 (8) ◽  
pp. 3235 ◽  
Author(s):  
Amira Mohammed Badawy
Keyword(s):  
Postoperative Pain ◽  
Primary Outcome ◽  
Laparoscopic Hysterectomy ◽  
Visual Analogue Score ◽  
Local Anaesthetics ◽  
Nausea And Vomiting ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Group A ◽  
Group B

Background: Laparoscopic hysterectomy is now an established operation, as it is less invasive and carries much less post-operative pain compared to open hysterectomy. However, post-laparoscopy analgesia is still a challenge. Intraperitoneal (IP) instillation of local anaesthetics has been shown to minimize postoperative pain after laparoscopic surgeries. This study was conducted to evaluate the efficacy of IP instillation of dilute analgesia prior the end of laparoscopic hysterectomy to reduce postoperative pain. The primary outcome was to assess postoperative pain scores. Secondary outcomes included assessment of postoperative analgesic requirements (type, amount, and timing), and frequency of nausea and vomiting.Methods: 20 cases were enrolled for laparoscopic hysterectomy and were divided randomly into two groups, Group A: 10 cases, where IP analgesia (Bupivacaine and Magnesium Sulphate) was instilled -under vision- prior removal of trocars, and Group B: 10 cases, where no IP analgesia was used. After surgery, Visual Analogue Score (VAS) was recorded at 6, 12, 24 hours and 7 days. Postoperative analgesic requirements (type, amount, and timing), and frequency of nausea and vomiting were also recorded.Results: The overall VAS during the first postoperative 24 hours was significantly lower in group A (P = 0.048, 0.049, and 0.003 at 6, 12, and 24 hours after surgery). Time to first of analgesia required (in hours) was longer (6.0±1.41 vs 3.20±1.48, P = 0.004) and total analgesic consumption (in mg) was lower (2.40±0.89 vs 3.30±0.67, P = 0.047) in group A compared to group B. The need for opioids was also significantly less in group A (3 cases vs 8 cases, P = 0.024). in group A, nausea and vomiting were less reported as well (P = 0.040).Conclusions: The instillation of local IP dilute analgesia is an effective and safe method for reducing pain after laparoscopic hysterectomy.

scholarly journals COMPARATIVE EVALUATION OF POSTOPERATIVE PAIN SCORES AND OPIOID CONSUMPTION IN SEPTORHINOPLASTY AFTER ADMINISTRATION OF SINGLE-DOSE PRE-EMPTIVE PARACETAMOL AND IBUPROFEN: A RANDOMIZED CONTROLLED TRAIL

2021 ◽  
Vol 9 (10) ◽  
pp. 1136-1143
Author(s):  
Alshehri a ◽  
◽  
Ali Abdullah A. ◽  
Keyword(s):  
Single Dose ◽  
Postoperative Pain ◽  
Analgesic Effect ◽  
Opioid Analgesics ◽  
Opioid Consumption ◽  
Control Group ◽  
Time Intervals ◽  
Pain Scores ◽  
Group A ◽  
Group B

Introduction Septorhinoplasty operates on cartilage and bone of the nose and is ensued by severe postoperative pain. The objective of this study is to evaluate effects of preoperative administration of intravenous (IV) paracetamol and ibuprofen on postoperative pain scores in patients undergoing septorhinoplasty. Methodology 150 patients undergoing septorhinoplasty were randomly assigned into three groups with 50 patients in each group. The control group (Group A) was administered 100 ml saline solution, paracetamol group (Group B) was administered 1000 mg IV paracetamol in 100 ml saline and ibuprofen group (Group C) was administered 800 mg IV ibuprofen in 100 ml saline before surgery. Opioid analgesics were employed to achieve postoperative analgesia. Postoperative pain was evaluated using Visual Analogue Scale (VAS). Postoperative opioid consumption and adverse effects were also recorded for each patient. Results In comparison with Group A, VAS in Group B and Group C was statistically lower in all the time intervals (p<0.05). In 1st and 6th hours postoperatively, VAS in Group C was lower than Group B (p<0.05). In control group, total opioid consumption was highest in all time intervals (p<0.05). In Group C, total opioid consumption was significantly lower than Group B at 0-6 and 6-12 hours interval. (p<0.05). Conclusion- Single-dose pre-emptive administration of ibuprofen has more profound postoperative analgesic effect than paracetamol during first 6 hours in septorhinoplasty. After first 6 hours of the procedure, there is no difference in analgesic effect between ibuprofen and paracetamol.

scholarly journals Efficacy of Intraperitoneal Bupivacaine on Pain Relief After Laparoscopic Cholecystectomy

PRILOZI ◽  
2018 ◽  
Vol 39 (1) ◽  
pp. 123-129 ◽  
Author(s):  
Marija Toleska ◽  
Andrijan Kartalov ◽  
Biljana Kuzmanovska ◽  
Milcho Panovski ◽  
Mirjana Shosholcheva ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Local Anesthetic ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Intraperitoneal Instillation ◽  
Group A ◽  
Vas Scores ◽  
Group B

Abstract Introduction: Patients undergoing laparoscopic cholecystectomy do experience postoperative pain, especially in the abdomen. Postoperative pain management remains a major challenge after laparoscopic procedures. Administration of intraperitoneal local anesthetic (IPLA) after surgery is used as a method of reducing postoperative pain. In this study, we evaluated the effect of intraperitoneal infiltration of local anesthetic (bupivacaine) for pain relief after laparoscopic cholecystectomy. Material and methods: In this prospective, controlled, and randomized study were included 50 patients aged 25-60 years (35 female and 15 male), scheduled to laparoscopic cholecystectomy with ASA classification 1 and 2. Patients were classified randomly into two groups: group A, which included 25 patients who received intraperitoneal instillation of bupivacaine 0.5% 20 ml; and group B, which included 25 patients who didn’t receive any intraperitoneal instillation. Postoperative pain was recorded using the visual analogue scale (VAS) for 24 hours after laparoscopic cholecystectomy. Results: There was no significant difference with respect to age, weight, and sex; duration of surgery; and anesthesia time. VAS scores at different time intervals were statistically significantly lower at all times in group A compared to group B. There were statistically significant differences in VAS scores between group A and group B at all postoperative time points - 1hr,4 hr,8 hr,12hr and 24hr (p < 0.00001). Conclusion: Intraperitoneal instillation of bupivacaine provides good analgesia in the postoperative period after laparoscopic cholecystectomy.

scholarly journals A comparison of bupivacaine lavage and diclofenac suppository effects on post-operative pain of laparascopic transabdominal pre-peritoneal herniorrhaphy: a randomized clinical trial study

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Alireza Negahi ◽  
Seyed Hamzeh Mousavi ◽  
Vahid Abbasnezhad ◽  
Fatemeh Jahanshahi
Keyword(s):  
Clinical Trial ◽  
Postoperative Pain ◽  
Randomized Clinical Trial ◽  
Laparoscopic Herniorrhaphy ◽  
Topical Anaesthetic ◽  
Time Points ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Significant Difference ◽  
Duration Of Hospitalization

Abstract Objectives Injection of a topical anaesthetic has been proved to be helpful with reducing pain after laparoscopic herniorrhaphy. We aimed to assess the effect of bupivacaine lavage on postoperative pain and compare it with diclofenac suppository. In this randomized clinical trial, 60 patients—scheduled for laparoscopic herniorrhaphy—were enrolled and randomized into three groups of 20 each, including diclofenac suppository, bupivacaine lavage, and normal saline as a placebo.The patients were investigated for postoperative pain scores, vomiting, nausea, morphine request, and duration of hospitalization. Results In the bupivacaine group, pain levels in recovery room, 4, 8 and 12 h after surgery, were significantly lower than diclofenac group; at time points of 16, 20 and 24 h after surgery, difference between two groups was not significant. Regarding vomiting and nausea, at time points of 1 and 3 h after surgery, results show no significant difference between the groups. Incident of infection, 1 h and 1 week after the surgery, was not significantly different among the groups. Duration of hospitalization in the bupivacaine group was much lower than the diclofenac group. Based on our results, use of the bupivacaine lavage can reduce postoperative pain in patients undergoing laparoscopic herniorrhaphy. Trial Registration Randomized clinical trial IRCT20180522039782N2; date of registration:14/10/2018

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