Outcome of Transperitoneal Laparoscopic Nephrectomy Using Multimodal Analgesia in Terms of Postoperative Pain Control and Recovery: A Randomised Double Blind Control Trial
Journal Title: Scholars Journal of Applied Medical Sciences - Year 2017, Vol 5, Issue 12
Abstract
Abstract: Transperitoneal laparoscopic nephrectomy (TLN) is presently the gold standard approach for both simple and radical nephrectomy. Though minimally invasive, TLN patients experience significant postoperative pain. We tried to evaluate the role of multimodal analgesia on postoperative pain control and recovery, both in terms of efficacy and safety. Forty patients of transperitoneal laparoscopic nephrectomy (both benign and malignant pathology), aged between 30-75 years; of both sex; ASA I-III; were randomly allocated in two groups. Group-P(n=21) received 100 mL of Paracetamol IV over 10 min, 15 min before induction, Group-C (n=19) received 100 ml normal saline instead of paracetamol. Protocol of induction and maintenance of anesthesia was same in both the groups. At the end of surgery both groups received port site infiltration block with 25 ml of 0.5% levobupivacaine. Post-operative pain and sedation were assessed at 10 mints, 30 mints, 45mints, 1hr, 2hr, 4hr, 6hr, 8hr, 12hr, 24 hr and 48 hours with VAS scores/sedation score. Fentanyl 1 µg/kg was used as rescue analgesic when VAS > 4. Data of intra-operative variables, postoperative pain relief, rescue analgesics requirement, and patient satisfaction were compared. VAS scores were similar in both the groups during first four postoperative hours, but at 8th, 12th, 24th and 48thpostoperative hour VAS score in Group-C was significantly higher (p<0.05). 1st rescue analgesic requirement was delayed in Group-p compared to group-C (287±18.3 vs244±12.6) and the total postoperative 24hrs fentanyl consumption was also found to be lower in Group P (120 ±45.91 vs 250 ±70.34) (p<0.05). Group-P had shorter SICU and hospital stay. Group-P showed higher patient satisfaction also.Intravenous paracetamol infusion and levobupivacaine wound site infiltration as part of multimodal analgesia effectively control post-operative pain after transperitonial laparoscopic nephrectomy.It also reduces postoperative fentanyl consumption and provide excellent patient satisfaction with no added side effects. Keywords:Laparoscopic nephrectomy, Multimodal analgesia, intravenous paracetamol, levobupivacaine infiltration.
Authors and Affiliations
Debansu Sarkar, Saikat Mojumdar, T K Mondal, Atanu Jana, Tapabrata Mitra, Haripada Das
Keywords
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