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Agarwal A, Zangmo R, Garg D, Roy KK, Sarkar A, Kulshreshtha A, Saha A. Comparison of Intraperitoneal Irrigation With Sodium Bicarbonate Versus Normal Saline in Reducing Pain After Operative Laparoscopy: A Randomized Controlled Trial. Cureus 2023; 15:e47686. [PMID: 38021625 PMCID: PMC10673706 DOI: 10.7759/cureus.47686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Background It has been postulated that sodium bicarbonate can reduce postoperative pain by neutralizing the acidic peritoneal environment created by carbon dioxide. It also prevents phrenic nerve damage and peritoneal irritation. The present study is a randomized controlled trial aimed at studying the effects of sodium bicarbonate in reducing postoperative pain in laparoscopic gynecological surgeries. Materials and methods This was a single-center, prospective, two-arm, double-blinded randomized control trial in which intraperitoneal irrigation with sodium bicarbonate was compared with normal saline in operative laparoscopy. Group I (intervention group) consisted of 40 patients who received intraperitoneal sodium bicarbonate, and Group II (control group) consisted of 40 patients who received normal saline. All procedures were conducted under general anesthesia. Postoperative pain scores were compared between intervention and control groups. Results The most common indication of laparoscopy was infertility. There was no difference in the duration of surgery between the two arms (p=0.27). The mean value of the visual analog scale (VAS) score at the shoulder tip was found to be significantly reduced in the intervention group at two hours (p=0.02), four hours (p=0.0009), and 12 hours (p=0.0002) after surgery. The mean VAS score at the abdomen and port sites was also found to be significantly reduced in the intervention group in the first 24 hours after surgery (p<0.05). With the increase in the time period from surgery, the mean VAS scores decreased in both intervention and control groups. Conclusion Intraperitoneal irrigation with sodium bicarbonate is beneficial in reducing postoperative pain in operative laparoscopy. However, multicenter randomized trials with a greater number of participants will be helpful to confirm the findings.
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Affiliation(s)
- Ankita Agarwal
- Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Rinchen Zangmo
- Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Deepali Garg
- Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Kallol K Roy
- Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Avir Sarkar
- Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Anshul Kulshreshtha
- Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Ashmita Saha
- Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
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Roy KK, Kanikaram PK, Singh N, Riwari V, Zangmo R, Meena J, Das A, Kashyap D, Minz A. Vaginal Vault Infiltration with Bupivacaine for Postoperative Pain Control after Total Laparoscopic Hysterectomy: A Randomized control trial. Gynecol Minim Invasive Ther 2023; 12:90-95. [PMID: 37416102 PMCID: PMC10321338 DOI: 10.4103/gmit.gmit_125_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 07/08/2023] Open
Abstract
Objectives The objective of this study was to assess the effect of local infiltration of anesthetic to the vaginal vault on postoperative pain after total laparoscopic hysterectomy. Materials and Methods This was a single-center, randomized trial. Women assigned to laparoscopic hysterectomy were randomly divided into two groups. In the intervention group (n = 30), the vaginal cuff was infiltrated with 10 ml of bupivacaine, whereas the control group (n = 30) did not receive local anesthetic infiltration to vaginal vault. The primary outcome measure was to analyze the efficacy of bupivacaine infiltration in the study group by comparing the postoperative pain in both the groups at 1, 3, 6, 12, and 24 h using pain visual analog scale (VAS). The secondary outcome was to measure the need for rescue opioid analgesia. Results Group I (intervention group) had lesser mean VAS score at 1st, 3rd, 6th, 12th, and 24 h compared to Group II (control group). There was an additional requirement of opioid analgesia for postoperative pain in Group II than in Group I, which was statistically significant (P < 0.05). Conclusion Injection of local anesthetic into the vaginal cuff increased the number of women experiencing only minor pain after laparoscopic hysterectomy and decreased postoperative opioid usage and its side effects. Local anesthesia of the vaginal cuff is safe and feasible.
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Affiliation(s)
- Kallol Kumar Roy
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | | | - Nilanchali Singh
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Vimi Riwari
- Department of Anaesthesia, AIIMS, New Delhi, India
| | - Rinchen Zangmo
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Jyoti Meena
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Anamika Das
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Deepika Kashyap
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Archana Minz
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
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Otake A, Sasamoto N, Sato N, Kumasaka R, Yamamoto Y, Adachi K. Comparative Study of Postoperative Analgesic Effects of Intraoperative Levobupivacaine Local Infiltration Anesthesia and Transversus Abdominis Plane Block Following Gynecologic Laparoscopy. Gynecol Minim Invasive Ther 2022; 11:231-237. [PMID: 36660329 PMCID: PMC9844037 DOI: 10.4103/gmit.gmit_120_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 04/14/2022] [Accepted: 05/04/2022] [Indexed: 01/22/2023] Open
Abstract
Objectives We aim to assess the postoperative analgesic effect of intraoperative levobupivacaine local infiltration anesthesia (LA) and transversus abdominis plane (TAP) block in gynecologic laparoscopy. Materials and Methods We conducted a retrospective analysis on the data of 260 patients treated by gynecologic laparoscopy (adnexal surgery, hysterectomy, and myomectomy) between January 2019 and December 2020 at Minoh City Hospital, Osaka Japan. Patients were divided into two groups: intraoperative LA group and TAP block group. We assessed clinical characteristics, surgical results, postoperative numerical rating scale (NRS) pain scores, and the frequency of analgesic use up to 24 h after surgery in overall and by each type of surgery. Pearson's χ2 test, Fisher's exact test, and Wilcoxon/Kruskal-Wallis test were used for statistical analysis. Multiple regression analysis was used for multivariate analysis. Results NRS pain score was statistically significantly higher in the LA group than in the TAP group 1 h after surgery in overall (P = 0.04), with NRS difference of 0.4 which was not clinically significant. No significant differences were observed in NRS pain scores at 3, 6, 12, and 24 h after surgery or in the frequency of analgesic use up to 24 h after surgery in overall and by type of surgery. Endometriosis was associated with increased postoperative pain at 1 h after surgery in adnexal surgeries (P = 0.04) and suggestive for all surgeries. Younger age was related to more frequency of analgesic use up to 24 h after surgery in overall, adnexal surgeries, and hysterectomy. Conclusion Intraoperative levobupivacaine LA may have similar postoperative analgesic effects as TAP block in gynecologic laparoscopy.
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Affiliation(s)
- Akiko Otake
- Department of Obstetrics and Gynecology, Minoh City Hospital, Minoh, Osaka, Japan,Address for correspondence: Dr. Akiko Otake, Department of Obstetrics and Gynecology, Minoh City Hospital, 5-7-1, Kayano, Minoo, Osaka 562-8562, Japan. E-mail:
| | - Naoko Sasamoto
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Noriko Sato
- Department of Obstetrics and Gynecology, Minoh City Hospital, Minoh, Osaka, Japan
| | - Ryota Kumasaka
- Department of Obstetrics and Gynecology, Minoh City Hospital, Minoh, Osaka, Japan
| | - Yoshimitsu Yamamoto
- Department of Obstetrics and Gynecology, Minoh City Hospital, Minoh, Osaka, Japan
| | - Kazushige Adachi
- Department of Obstetrics and Gynecology, Minoh City Hospital, Minoh, Osaka, Japan
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Analgesia for Gynecologic Oncologic Surgeries: A Narrative Review. Curr Pain Headache Rep 2022; 26:1-13. [PMID: 35118596 DOI: 10.1007/s11916-022-00998-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Gynecologic oncologic malignancies are amongst the most common cancers affecting women across the world. This narrative review focuses on the current state of evidence around optimal perioperative pain management of patients undergoing surgeries for gynecologic malignancies with a specific focus on cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). RECENT FINDINGS Recent improvements in postoperative pain management following all types of gynecologic procedures, including minimally invasive, open-abdominal, or CRS + HIPEC, have been implemented through enhanced recovery after surgery (ERAS) protocols. These protocols encompass the use of preemptive analgesia, neuraxial and regional techniques, local anesthetic infiltration, and multimodal analgesia. The severity of postoperative pain varies for minimally invasive cancer surgery to open debulking procedures. Therefore, an individualized perioperative analgesic plan is critical depending on the surgical approach. For CRS + HIPEC, neuraxial techniques such as thoracic epidurals and opioid sparing multimodal analgesics have shown efficacy in the perioperative period. However, future research is needed as many of these patients develop chronic pain with very limited research done in this realm.
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Sethi D, Garg G. Analgesic efficacy of ultrasound-guided transversus abdominis plane block for laparoscopic gynecological surgery: a randomized controlled trial. Anesth Pain Med (Seoul) 2022; 17:67-74. [PMID: 34991187 PMCID: PMC8841257 DOI: 10.17085/apm.21030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 11/21/2021] [Indexed: 11/17/2022] Open
Abstract
Background This study aimed to determine whether ultrasound-guided transversus abdominis plane (TAP) block is more effective in reducing postoperative pain and analgesic consumption than local anesthetic infiltration (LAI) at the port site for elective laparoscopic gynecological surgeries. Methods Eighty patients with the American Society of Anesthesiologists status I/II undergoing laparoscopic gynecology surgery were enrolled for this randomized control trial. After general anesthesia was administered, patients in group C received LAI at each port site, and patients in group T received bilateral ultrasound-guided TAP block. Postoperative pain was assessed at time intervals of 1/2, 2, 4, 6, 8, and 24 h using the numeric rating scale (NRS). Clinical metrics such as postoperative analgesic diclofenac consumption, need for rescue fentanyl, nausea-vomiting scores, and antiemetic requirements were also recorded. Results Seventy-four patients were included in the final analysis. Postoperatively, patients in group T had significantly lower NRS than those in group C (P < 0.05). The highest difference in the postoperative NRS was observed at 2 h (median [1Q, 3Q]; group C = 3 [2, 4]; group T = 1 [0, 2]; P < 0.001). A statistically significant difference was observed in the frequency of diclofenac (75 mg intravenous) requirement between the groups (P = 0.010). No significant difference was observed between the groups in need of rescue fentanyl or antiemetic and the nausea-vomiting scores. Conclusions In patients undergoing laparoscopic gynecological surgery, ultrasound-guided TAP block provided greater postoperative analgesic benefits in terms of lower NRS and reduced analgesic requirements than port site LAI.
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Affiliation(s)
- Divya Sethi
- Department of Anesthesia and Critical Care, Employees' State Insurance Cooperation Postgraduate Institute of Medical Sciences and Research (ESIC-PGIMSR), New Delhi, India
| | - Garima Garg
- Department of Anesthesia and Critical Care, Employees' State Insurance Cooperation Postgraduate Institute of Medical Sciences and Research (ESIC-PGIMSR), New Delhi, India
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Updates on Wound Infiltration Use for Postoperative Pain Management: A Narrative Review. J Clin Med 2021; 10:jcm10204659. [PMID: 34682777 PMCID: PMC8537195 DOI: 10.3390/jcm10204659] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/03/2021] [Accepted: 10/08/2021] [Indexed: 12/29/2022] Open
Abstract
Local anesthetic wound infiltration (WI) provides anesthesia for minor surgical procedures and improves postoperative analgesia as part of multimodal analgesia after general or regional anesthesia. Although pre-incisional block is preferable, in practice WI is usually done at the end of surgery. WI performed as a continuous modality reduces analgesics, prolongs the duration of analgesia, and enhances the patient’s mobilization in some cases. WI benefits are documented in open abdominal surgeries (Caesarean section, colorectal surgery, abdominal hysterectomy, herniorrhaphy), laparoscopic cholecystectomy, oncological breast surgeries, laminectomy, hallux valgus surgery, and radical prostatectomy. Surgical site infiltration requires knowledge of anatomy and the pain origin for a procedure, systematic extensive infiltration of local anesthetic in various tissue planes under direct visualization before wound closure or subcutaneously along the incision. Because the incidence of local anesthetic systemic toxicity is 11% after subcutaneous WI, appropriate local anesthetic dosing is crucial. The risk of wound infection is related to the infection incidence after each particular surgery. For WI to fully meet patient and physician expectations, mastery of the technique, patient education, appropriate local anesthetic dosing and management of the surgical wound with “aseptic, non-touch” technique are needed.
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