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Comparación de bupivacaína, sulfato de magnesio y su combinación para analgesia postoperatoria en pacientes de colecistectomía laparoscópica
Comparative evaluation of intraperitoneal bupivacaine, magnesium sulfate and their combination for postoperative analgesia in patients undergoing laparoscopic cholecystectomy. Anand S, Bajwa SS, Kapoor B B, Jitendera M, Gupta H. Niger J Surg Sci [serial online] 2014 [cited 2015 Jan 21];24:42-8. Abstract Background: Various multimodal techniques have been employed time and again to allay visceral pain after laparoscopic cholecystectomy. Aim: The aim of this study was to assess and compare the postoperative pain relief in patients undergoing laparoscopic cholecystectomy with intraperitoneal administration of bupivacaine, magnesium sulfate and their combination. Materials and Methods:Patients were randomly divided into four groups of 20 each. Patients in group I "C" received 50 ml of 0.9% saline, group II "B" received 50 ml of 0.25% bupivacaine, group III "M" received 50 ml of 30 mg/kg magnesium sulfate, while patients in group IV "MB" received 0.125% of bupivacaine with 15 mg/kg of magnesium sulfate to a total volume of 50 ml after surgery. Postoperatively pain was assessed using visual analog scale (VAS) and postoperative pain (VAS > 3) was managed with intravenous tramadol 50 mg. Time to the first request of analgesia, the total number of analgesic doses of tramadol, the incidence and severity of postoperative shoulder pain in 24 h and presence of complications if any were noted. Results: Demographic profile of patients of all the four groups was comparable and statistically nonsignificant. Intraperitoneal instillation of 0.25% bupivacaine provided longest duration of analgesia for 541.5 131.48 min with a significant reduction in the number of doses of intramuscular tramadol in 24 h. Intraperitoneal instillation of 30 mg/kg magnesium sulfate provided analgesia for 82.25 35.37 min with no significant reduction in a number of doses of intramuscular tramadol in 24 h when compared to control. Intraperitoneal instillation of mixture of bupivacaine and magnesium sulfate in reduced doses, that is, 0.125% bupivacaine and 15 mg/kg magnesium sulfate provided analgesia for 305 65.64 min with a significant reduction in a number of doses of intramuscular tramadol in 24 h. There was reduced incidence and severity of shoulder pain, which was comparable in all the four groups. No significant side-effects were seen in any of the groups. Conclusion: Intrape-ritonel administration of bupivacaine, magnesium sulfate and their combination in reduced doses provides effective postoperative analgesia in laparoscopic cholecystectomy patients though their combination when the doses of both the drugs were reduced to half was less effective than bupivacaine group alone. Furthermore, bupivacaine and magnesium sulfate serve as useful adjuncts to postoperative analgesics. Keywords: Bupivacaine, laparoscopic cholecystectomy, magnesium sulphate, postoperative analgesia
BACKGROUND: Postoperative pain is a major complaint following laparoscopic cholecystectomy. OBJECTIVES: The aim of this study was to compare the impact of intraperitoneal hydrocortisone with intraperitoneal bupivacaine on pain relief after laparoscopic cholecystectomy. PATIENTS AND METHODS: In a double blind clinical trial, 63 candidates for laparoscopic cholecystectomy were randomly allocated to receiveintraperitoneal instillation of either 100 mg bupivacaine in 250 mL normal saline (n = 32) or 100 mg hydrocortisone in 250 mL normal saline (n = 31) before insufflation of CO2 into the peritoneum for postoperative pain relief. Patients were investigated regarding abdominal and shoulder pain using (visual analog scale) VAS in recovery room and at 6, 12 and 24 hours postoperatively. Patients were also followed regarding postoperative analgesic requirements, nausea and vomiting, and return of bowel function. RESULTS: Sixty patients completed the study. Patients in the hydrocortisone group had no statistically significant abdominal and shoulder pain scores compared to the bupivacaine group. The patients were similar regarding postoperative analgesic requirements, return of bowel function, nausea and vomiting. No adverse effect was detected in either group. CONCLUSIONS: Intraperitoneal administration of hydrocortisone is as effective as bupivacaine to reduce pain and analgesic requirements after laparoscopic cholecystectomy.
BACKGROUND: Postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy (LC) has multifactorial etiology. Pain and use of opioids are among the important factors. OBJECTIVES: The present study aimed to evaluate the efficacy of intrapritoneal (IP) injection of bupivacaine on PONV. PATIENTS AND METHODS: This was a double-blind randomized clinical trial, conducted on 66 patients aged 20-60, ASA I or II, candidates for LC. Patients were randomly assigned to two groups. Bupivacaine group received 20 mL bupivacaine 0.25% in the gallbladder bed, before and after cholecystectomy and the control group did not. The incidence of nausea and postoperative pain intensity was measured with Visual analogue scale (VAS) at 1, 2, 3 and 4 hours after operation, at rest and when coughing and changing positions. Nausea and vomiting occurrence were assessed at the same times. RESULTS: There were no demographic data differences between groups. No differences were found between the two groups, in terms of incidence of nausea and vomiting. Furthermore, both groups were similar with respect to opioid consumption, during four hours post-operation. CONCLUSIONS:Intraperitoneal bupivacaine administration at the beginning and end of laparoscopic cholecystectomy reduced only visceral and shoulder pains at the 4th postoperative hour, but had no effect on reducing neither PONV, nor opioid demand, during the first four postoperative hours.
KEYWORDS: Bupivacaine; Cholecystectomy; Laparoscopic; Postoperative Nausea and Vomiting PDF