Background: Postoperative pain following laparoscopic cholecystectomy (LC) arises from incision sites and residual intraperitoneal CO2 gas. Opioids as a class of pain-relieving drugs are broadly used to control pain after LC; however, these drugs can cause various side effects. Objectives: The purpose of this study was to compare the efficacy of intraperitoneal injection of bupivacaine with that of intravenous ketorolac in managing postoperative pain in patients who had undergone LC. Methods: This randomized, double-blind clinical trial was carried out on patients who had undergone LC. Ninety patients who had undergone elective LC were randomly divided into 3 groups (n = 30 for each group). Group A received 40 mL of 0.25% bupivacaine solution intraperitoneally at the end of the operation; group B received 30 mg of ketorolac intravenously 30 minutes before surgery and every 8 hours after surgery, and patients in group C received normal saline intraperitoneally and intravenous injection. The patients were postoperatively assessed for Visual Analog Scale (VAS) scores, postoperative opioid consumption, shoulder pain, side effects (sedation, nausea, and vomiting), and satisfaction. The data were analyzed using SPSS. P values < 0.05 were considered significant. Results: The intraperitoneal injection of bupivacaine and intravenous injection of ketorolac were significantly effective in reducing postoperative abdominal pain, shoulder pain, and incidence of nausea and vomiting compared to the placebo group (P < 0.001). Although intraperitoneal bupivacaine and intravenous ketorolac had no significant difference in pain relief compared with each other, patients in both bupivacaine and ketorolac groups were significantly more satisfied with their analgesia compared to the control group (P < 0.001). Conclusions: Intraperitoneal injection of bupivacaine and intravenous injection of ketorolac both are safe and effective methods to control pain, nausea, and vomiting after LC.

Background- Congenital hypothyroidism (CH) is the most frequent cause of mental retardation in children. Despite the success of the screening programs in detecting CH cases, high recalling rate and false positive results impose a burden to the health system worldwide. Although cord blood thyroid stimulating hormone (CBTSH) is an accepted screening tool for CH, data about it are sparse in Iran. Therefore, we aimed to evaluate the umbilical cord blood TSH and Free T4 and its relationship with maternal and neonatal factors, as well as heel-stick TSH. Methods- This study included 120 mother-newborn pairs in Amir-Al-Momenin Hospital, Semnan, Iran from October 2021 to May 2022. The mean values of Free T4 and CBTSH were measured with respect to various maternal and neonatal factors. The heel-stick TSH on day 2-3 after birth were determined in all participants. Results- The mean CBTSH concentration was significantly higher in preterm newborns and male sex than term newborns and females (P=0.039 and P<0.001, respectively). Newborns born via cesarean section had lower CBTSH levels than those born by vaginal deliveries (P=0.040). The CBTSH was also positively correlated with heel-stick TSH (P<0.001). The mean umbilical cord blood Free T4 was significantly higher in multigravida newborns than primigravida cases (P=0.023). There was no statistically significant relation between umbilical cord blood Free T4 and TSH and maternal age, preeclampsia, gestational diabetes, twin or singleton delivery, 1- and 5- minutes Apgar scores, birthweight, and cord gases (P>0.05). The optimal cut-off point of CBTSH for discrimination of suspicious cases to hypothyroidism was 14.75 mIU/L. Conclusions- Method of delivery, gestational age, and male sex were influential variables on the umbilical cord TSH that must be considered when interpreting the results of the CBTSH. This study augments findings that CBTSH may be considered a predictive factor in CH screening programs.