Objective: To compare the postoperative pain relief quality of intra-incisional local infiltration of lidocaine-bupivacaine mixture, pre-or post-laparoscopic cholecystectomy. Methods: Our prospective and randomized investigation included 110 adult patients, of both genders, middle aged, classed I-II by the American society of anesthesiologists and scheduled for elective laparoscopic cholecystectomy after written informed consent and local ethics committee approval had been obtained at Prince Ali Bin Hussein Hospital, Karak-Jordan, during the period of January 2012 to July 2013. After induction of intravenous general anesthesia, patients were divided into two groups in a random manner. Group I received local infiltration prior to incision of 15ml of bupivacaine 0.25% mixed with 5ml of lidocaine 1%, subcutaneously, 14ml in the 10mm trocar site incisions and 6ml at the 5mm trocar site. Group II received the same volume; dose and division of local anesthesia incisional injection after the trocar sites were sutured. Postoperative pain quality was evaluated during the first six postoperative hours using the visual analogue scale, and the data was analyzed for significance. Results: Mean postoperative pain score was significantly less in group II than in group I, especially at six hours where it was 3.1 and 1.1 in groups I and II, respectively (p<0.05). Postoperative morphine demand was 78.8% and 41.4% in groups I and II, respectively (p<0.05). Conclusions: Intraincisional local infiltration after incision suturing is more effective than before incisions making, in managing postoperative pain after laparoscopic cholecystectomy.

This study investigates the effect of intramuscular ketamine on emergence agitation (EA) following septoplasty and open septorhinoplasty (OSRP) when administered at subanesthetic doses at the end of surgery. A random sample of 160 ASA I-II adult patients who underwent septoplasty or OSRP between May and October, 2022, was divided into two groups of eighty patients each: ketamine (Group K) and saline (Group S) with the latter serving as the control group. At the end of surgery immediately after turning off the inhalational agent, Group K was administered with intramuscular 2 ml of normal saline containing 0.7 mg/kg ketamine and Group S with 2 ml of intramuscular normal saline. Sedation and agitation scores at emergence from anesthesia were recorded after extubation using the Richmond Agitation-Sedation Scale (RASS). The incidence of EA was higher in the saline group than in the ketamine group (56.3% vs. 5%; odds ratio (OR): 0.033; 95% confidence interval (CI): 0.010–0.103; p < 0.001 ). Variables associated with a higher incidence of agitation were ASA II classification (OR: 3.286; 95% (CI): 1.359–7.944; p = 0.008 ), longer duration of surgery (OR: 1.010; 95% CI: 1.001–1.020; p = 0.031 ), and OSRP surgery (OR: 2.157; CI: 1.056–5.999; p = 0.037 ). The study concluded that the administration of intramuscular ketamine at a dose of 0.7 mg/kg at the end of surgery effectively reduced the incidence of EA in septoplasty and OSRP surgery.