Introduction: Patients undergoing laparoscopic cholecystectomy have moderate post-operative pain in the early post-operative period. There are several modalities to manage pain in the postoperative period. Subcostal transversus abdominis plane block is one of the effective methods for pain management. The objective of our study was to compare the analgesic efficacy of subcostal transversus abdominis block versus local infiltration at the port site with bupivacaine in patients undergoing Laparoscopic cholecystectomy under general anesthesia. Methodology: This is a prospective randomized study of 60 patients of age group 18 – 60 years of either gender, of ASA PS I and II scheduled for laparoscopic cholecystectomy under general anesthesia and were randomly divided into two groups. At the end of the surgery 20ml of 0.25% bupivacaine was administered with ultrasound guided subcostal transversus abdominis plane block bilaterally in group T and local infiltration at the port sites in group L. Visual analogue scale at 0, 2, 6, 12 and 24 hours at rest, time of rescue analgesia and opioids consumption were recorded. Results: Both the groups were comparable with each other to assess pain scores and analgesic requirements. Group T had less pain at rest (<0.001) on visual analogue scales and also less analgesic and opioids consumption compared to group L (<0.001), which were found to be statistically significant. Conclusion: Subcostal transversus abdominis plane block is beneficial, effective and reliable method in providing post-operative analgesia in patients after laparoscopic cholecystectomy compared to local infiltration at port sites.
Background and aims: Central venous catheterization is a widely used technique in the management of critically ill patients. Ultrasound-guided central venous catheterization has been shown to reduce complications and improve success rates. The internal jugular vein and subclavian vein are common access sites for central venous cannulation. In this study, we aim to compare these approaches in ultrasound-guided central venous catheterization. Methods: A prospective comparative study was conducted at a teaching hospital between August 2022 and January 2023. The study included adult patients requiring central venous catheterization for various indications. Participants were randomly allocated to one of three groups: internal jugular, supraclavicular, or infraclavicular approach. Puncture time, catheter insertion time, guidewire insertion time, success rates, number of attempts, guidewire misplacement, and complications were recorded. Results: The study comprised 143 patients, and there were no significant differences observed between the groups in terms of demographic characteristics. Mean puncture time and catheter insertion time were significantly shorter in the internal jugular group than in the other two groups. There were no significant differences in guidewire insertion time and success rates between the three groups. There were also no significant differences in complications or guidewire misplacement rates between the groups. Conclusion: In ultrasound-guided central venous catheterization, the internal jugular approach had a shorter puncture time and catheter insertion time than the supraclavicular and infraclavicular approaches, with no significant differences in guidewire insertion time, success rates, complications, or guidewire misplacement rates. Internal jugular approach may be the preferred approach for ultrasound-guided central venous catheterization.
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