Post-operative discomfort after ring or clip tubal ligation--is there any difference and do indomethacin suppositories help?

Effect of preoperative rectal indomethacin on postoperative pain reduction after open cholecystectomy

The preoperative administration of nonsteroidal anti-inflammatory drugs (NSAIDs) has been shown to have a positive impact on postoperative pain, but there is little research regarding the use of rectal NSAIDs given before surgery. The purpose of this study was to evaluate the effects of rectally administered indomethacin on postoperative pain in patients undergoing open cholecystectomy. A randomized controlled design was used to compare rectally administered indomethacin with placebo. Pain intensity, total opioid dose, and postoperative time to first request for analgesic were evaluated. The indomethacin group experienced significantly less postoperative pain and required less total opioid dose compared with the placebo group. Preoperative rectal administration of indomethacin reduces postoperative pain in open cholecystectomy when compared with placebo.

Rectal diclofenac analgesia after abdominal hysterectomy

Sixty-two patients undergoing total abdominal hysterectomy with or without salpingo-oophorectomy were randomly allocated to received either 100 mg rectally of diclofenac (n = 31) or a placebo (n = 31) at the end of the operation and 12-hourly for 72 hours postoperatively. The analgesic effect of the diclofenac was measured by a visual analogue scale pain score and morphine usage. Patients receiving diclofenac showed a morphine requirement of < 50% of the patients receiving placebo (p < 0.0001). There was no statistical evidence of any reduction in the incidence of nausea and vomiting with the use of diclofenac.

The effect of glycopyrrolate on postoperative pain and analgesic requirements following laparoscopic sterilisation

In order to evaluate the contribution of tubal spasm to pelvic pain following laparoscopic sterilisation, we have studied the effect of glycopyrrolate, an anticholinergic agent with antispasmodic properties, on 60 ASA 1 and 2 patients presenting as day-cases for laparoscopic sterilisation using Filshie clips. In a randomised, double-blind, controlled trial, patients received either glycopyrrolate 0.3 mg or saline intravenously prior to induction of anaesthesia. Compared with the control group, patients receiving glycopyrrolate had significantly reduced immediate postoperative pain scores (p < 0.02) and required significantly less postoperative morphine (p < 0.01). Nausea, vomiting and anti-emetic requirements were also reduced though not significantly. We conclude that glycopyrrolate 0.3 mg at induction of anaesthesia is an effective method of improving the quality of recovery after day-case laparoscopic sterilisation using clips.

Anaesthesia for laparoscopic general surgery

Laparoscopic surgery minimises postoperative morbidity. Patient benefits include reduction in postoperative pain, better cosmetic result and quicker return to normal activities. Hospital stay is shortened resulting in a reduction in overall medical cost. The intraoperative requirements of laparoscopic surgery however can lead to serious physiological changes and complications. While there is a low but definite perioperative mortality rate associated with minor gynaecologic laparoscopic procedures, laparoscopic general surgical procedures are performed on older patients and patients with acute surgical conditions and are likely to be associated with a higher incidence of perioperative complications. The major problems during laparoscopic surgery are related to the cardiopulmonary effects of pneumoperitoneum, systemic carbon dioxide absorption, extraperitoneal gas insufflation, venous gas embolism and unintentional injuries to intra-abdominal structures. An appraisal of the potential problems is essential for optimal anaesthetic care of patients undergoing laparoscopic surgery. Appropriate anaesthetic techniques and monitoring facilitate surgery and allow early detection and reduction of complications. The need for rapid recovery and short hospital stay impose additional demands on the anaesthetist for skillful practice.