BACKGROUNDPost laparoscopic cholecystectomy patients complain more of visceral pain as a result of stretching of the intra-abdominal cavity, peritoneal inflammation and phrenic nerve irritation caused by residual carbon dioxide in the peritoneal cavity. Intraperitoneal instillation of local anaesthetic agents has become an important method to control postoperative pain, nausea, vomiting and reduced hospital stay. The purpose of this double-blinded randomised controlled trial was to compare the analgesic efficacy of intraperitoneal instillation of local anaesthetic agents alone or in combination with opioids, ∝-2 agonists such as clonidine and dexmedetomidine to reduce postoperative pain following laparoscopic cholecystectomy. MATERIALS AND METHODS135 were equally divided into three, allocated to one of the groups by random allocation cards using computer generated random numbers. Group A (n= 45): Intraperitoneal bupivacaine 30 mL 0.25% + 5 mL normal saline (NS); Group B (n= 45): Intraperitoneal bupivacaine 30 mL 0.25% + tramadol 1 mg/kg (diluted in 5 mL NS); or Group C (n= 45): Intraperitoneal bupivacaine 30 mL 0.25% + dexmedetomidine 1 mcg/kg (diluted in 5 mL NS). RESULTSWe found bupivacaine in combination with tramadol (Group B) has significantly lower VAS score at all points of time (P < 0.001) and overall VAS score and postoperative analgesia was statistically lower than with Group A. But bupivacaine + dexmedetomidine had even better VAS score underlying high efficacy of drug. Time to first request of analgesia in postoperative period was significantly delayed in Group C as compared to Group A (P= 0.86). CONCLUSIONWe conclude that intraperitoneal instillation of dexmedetomidine 1 mcg/kg in combination with bupivacaine 0.25% in elective laparoscopic cholecystectomy significantly reduces the postoperative pain and significantly reduces the analgesic requirement in postoperative period as compared to bupivacaine 0.25% alone and may be better than bupivacaine combined with tramadol.

Post operative nausea and vomiting (PONV) continue to be frequent occurrences, even when conventional antiemetics are prophylactically used. In a randomized double blind study, 100 female patients scheduled for elective laparoscopic cholecystectomy under general anaesthesia were divided into 2 groups of 50 patients each and received 0.1mg/Kg of Ondansetron (Group X) or 0.04mg/Kg of Granisetron (Group Y) preoperatively. Patients were observed for 24 hours post operatively and interpretation of symptoms of nausea and vomiting was done according to Gan and Alexander scale (0-2). 80% of patients in Group Y and 48 % patients in Group X did not experience PONV; the difference was statistically significant (p<0.001). 2 patients (4%) in Group Y and 15patients (30%) in Group X required rescue antiemetic medication during the 24 hour study period. The difference was found to be highly significant (p<0.001) The difference in the incidence of PONV between the two groups after 6 hours to 24 hours was highly significant (p<0.001). It was concluded that prophylactic administration of Granisetron is more effective than Ondansetron, in reducing in incidence of PONV with prolonged effects.

Renal dysfunction following cardiopulmonary bypass is a frequent complication of open heart surgery. Acute renal failure requiring dialysis occurs in approximately 1.5% of patients following cardiac surgery and remains a cause of major morbidity and mortality. Method: Sixty-five patients of either sex in the age group of 10-50 years scheduled to undergo various cardiac procedures were included in this study. All patients had normal preoperative levels of serum creatinine, blood urea nitrogen, blood glucose levels, urine analysis, 24 hour urinary protein < 200 mg, and normal 24 hour creatinine clearance. After surgery, patients were transferred to an intensive care unit for postoperative management and monitoring. Patients were shifted to cardiovascular and thoracic surgery ward as soon as their clinical condition permitted. Blood urea nitrogen, serum creatinine, 24 hour creatinine clearance was performed on day one and day seven of postoperative period. Result: Postoperative oliguric acute renal failure was 7.7% and overall mortality was 6.1%. We found no association between aortic cross clamp time and postoperative renal dysfunction. Conclusion: Optimisation of cardiac performance post cardiopulmonary bypass seems to be the most important factor in the prevention of postoperative renal dysfunction in patients requiring total cardiopulmonary bypass.

No abstract

Background: Neuraxial administration of neostigmine alongwith local anaesthetics improves the quality of intraoperative analgesia and also provides postoperative pain relief for longer duration. The present study was conducted to study the efficacy and safety of intrathecal neostigmine with bupivacaine in two different doses.