Keywords : laparoscopic cholecystectomy

Using Single Dose Systemic Dexamethasone Pre Operatively for Postoperative Pain as Part of Multimodal Analgesia in Laparoscopic Cholecystectomy

Mohammad Shakoor Mugheer; Bashar taha Enad; Hassan Sarhan Haider

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 2, Pages 183-187

Pain after laparoscopy occurs for various reasons and a range of treatment have been suggested for the reduction in pain. There are reports that local anesthesia infiltration, removal of remaining carbon dioxide, administration of anti-inflammatory analgesia before surgery and dexamethasone are effective in post operative pain management. Recently multimodal analgesia methods, where a combination of the above methods are used, are recommended for their effectiveness.
Eighty patients aged 20-60 years; ASA class 1 &2;undergoing laparoscopic cholecystectomy under general anesthesia were studied and divided into two groups: Group S(n = 40) received dexamethasone 8 mg before induction ; Group N received 2ml normal saline before induction. We measure the degree of pain of both groups with VAS at 1,3,6&24 hours after surgery.
VAS score of Group S were lower than that of Group N during 24 hours after laparoscopic cholecystectomy and analgesia consumption of Group S were lower than that of Group N.
A single dose of dexamethasone (8mg) intravenously given before induction was effective in reducing postoperative pain after laparoscopic cholecystectomy with multimodal analgesia.

Comparison of the Effect of Dexamethasone and Metoclopramide in Prevention of Post-Operative Nausea and Vomiting in Laparoscopic Cholecystectomy

Iyad Abbas Salman; Redha Mohamed Abdul Hussien Alkabee

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 3, Pages 443-448

Postoperative Nausea and vomiting is Common complication depending on the type of surgery,
technique and duration of anesthesia.
To evaluate the effect of Dexamethasone as antiemetic in comparison with Metoclopramide.
Is aprospective study carried on (100) patients undergone elective cholecystectomy in a period
from Jan. 2009 to April. 2010 in Baghdad Teaching Hospital / Medical city/Baghdad/Iraq.
The patients were allocated into two groups of 50 patients each. Group A received 8mg
Dexamethasone, group B received 10mg metoclopramide intravenously, both groups monitored
postoperatively for nausea and vomitting for 24 hours every 4 hours.
Regarding Nausea, for 24 hrs the results were not significant except at 24th hr., in which nausea
more significant in metoclopramide group.
Regarding Vomiting, there was no significant from postoperative period to 12hr, while from 16 hr.
to 24 hr. there were significant fewer incidences in dexamethasone group.
A single dose of Dexamethasone is effective same as Metoclopramide in prevention of PONV ,
and it is better in late prevention postoperativel

Postoperative Pain Reduction with Bupivacaine Instillation After Laparoscopic Cholecystectomy

Sami Hasson; Firas AL Chalabi

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 2, Pages 186-191

Pain occurs frequently following laparoscopic cholecystectomy leading to increased patients
distress, delayed discharge, increase the need for analgesia and delayed oral intake
To evaluate the effect of bupivacaine instillation on pain relief in the early post- operative period
following laparoscopic cholecystectomy.
Eighty patients having symptomatic gall stones were included in this study. The procedure was
explained to the patients and informed consent was obtained. The patients were divided into two
groups: group (A) received 40 ml of(0.125%) bupivacaine diluted in 60 ml of isotonic saline(0.9%)
instilled in the subdiaphragmatic and subhepatic spaces, the remaining 40ml of (0.125%)
bupivacaine were used for wounds infiltration. The post operative pain was assessed by visual
analogue scale(VAS) at fixed time intervals, both patients and house officer doctor were blinded to
the group of the patients. Group (B) stood as a control group.
The two groups were comparable in age, gender, weight, and duration of operation. The male
to female ratio was (1:4), the mean age in both groups were insignificantly different, their
weights ranged from (58- 96) kg. Post operative abdominal pain was significantly lower in group A
(bupivacaine group) than group B ( control group) in the first twelve hours.
The mean abdominal pain score ranged from (3.85 to 2.55) for the bupivacaine group, and from
(6.62 to 3.16) in the control group, the p value is < 0.001which is highly significant in the first 6
hours. Group A had a lower incidence of shoulder pain in comparison with the control group
although statistically not significant.
Intraincisional infiltration with bupivacaine is a simple and feasible procedure which significantly
reduces post operative pain

Preoperative Prediction of Difficult Laparoscopic Cholecystectomy by Clinical Assessment and Ultrasonagraphy

Mohamed Salih Younis

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 2, Pages 196-201

Laparoscopic cholecystectomy(LC) has now replaced open cholecystectomy(OC) for the treatment of
gallbladder diseases. However, LC may be rendered difficult by various problems encountered during
surgery, such as difficulties in accessing the peritoneal cavity, dissecting the Calot’s triangle and gall
bladder, or extracting the excised gall bladder.
Of this prospective study: is to determine whether preoperative clinical parameter and Ultrasonagraphy
can predict difficult LC.
100 patients underwent LC in Al-Jamhuri Teaching Hospital, all had gallstone disease. Prospective
analyses of different preoperative clinical and ultrasonic parameters contributing to difficult LC were
performed. These included: age, gender, BMI (Body Mass Index), previous upper abdominal surgery,
previous attack of acute cholecystitis , gall bladders size , gall stones size and numbers. The outcomes
included the following operative parameters: access to peritoneal cavity, adhesion and difficult
dissection, bleeding during surgery, bile leak, and conversion to OC.
Of 100 patients with LC 41 patients (41%) developed difficulties during operation .Factors contributed
to difficult LC were male sex, previous upper abdominal surgery ,previous attack of acute cholecystitis
, BMI more than 35 and gall stones that were more than (1 cm) in diameters . The most common type
of difficulties was intraoperative bile leak (14%) and the least frequent difficulty was conversion to OC
Clinical and ultrasonographic findings can help to predict difficult LC .This information may be useful
to both the patients and surgeons in being better prepared for the intra-operative risk including
conversion to OC