Effect of intraperitoneal local anesthetic on pain characteristics after laparoscopic cholecystectomy

AIM : To systematically evaluate the effect of intraperitoneal local anesthetic on pain characteristics after laparoscopic cholecystectomy(LC).METHODS: We searched MEDLINE, EMBASE, and the Cochrane Library. Randomized controlled trials in English that compared the effect of intraperitoneal administration of local anesthetics on pain with that of placebo or nothing after elective LC under general anesthesia were included. The primary outcome variables analyzed were the combined scores of abdominal, visceral, parietal, and shoulder pain after LC at multiple time points. We also extracted pain scores at resting and dynamic states.RESULTS: We included 39 studies of 3045 patients in total. The administration of intraperitoneal local anesthetic reduced pain intensity in a resting state after laparoscopic cholecystectomy: abdominal [standardized mean difference(SMD) =-0.741; 95%CI:-1.001 to-0.48, P < 0.001]; visceral(SMD =-0.249; 95%CI:-0.493 to-0.006, P = 0.774); and shoulder(SMD =-0.273; 95%CI:-0.464 to-0.082, P = 0.097). Application of intraperitoneal local anesthetic significantly reduced the incidence of shoulder pain(RR = 0.437; 95%CI: 0.299 to 0.639, P < 0.001). There was no favorable effect on resting parietal or dynamic abdominal pain.CONCLUSION: Intraperitoneal local anesthetic as an analgesic adjuvant in patients undergoing laparoscopic cholecystectomy exhibited beneficial effects on postoperative abdominal, visceral, and shoulder pain in a resting state.

Measurement of biological age may help to assess the risk of colorectal adenoma in screening colonoscopy

AIM To investigate the clinical utility of biological age(BA) measurement in screening colonoscopy for the detection of colorectal adenomas in the average-risk population.METHODS A consecutive series of asymptomatic subjects aged ≥ 30 years who underwent colonoscopy in routine check-ups were enrolled. Colorectal adenoma was classified according to size, number, and location. BAs were calculated using the MEDIAGETM Biological Age Measurement System.RESULTS A total of 2696 subjects were investigated(1876 men and 820 women). The mean chronological age(CA) was 46.0 years and the mean BA was 44.7 years. Metabolic syndrome(MS) was diagnosed in 218 subjects(8.1%). The prevalence of overall colorectal adenoma was 23.1%(622/2,696). When the subjects were divided into four groups based on BA(≤ 39 years; 40-49 years; 50-59 years; ≥ 60 years), the prevalence of colorectal adenoma was increased as BA increased(P < 0.001). Colorectal adenoma located in the proximal colon was more prevalent in the BA-dominant group(BA-CA ≥ 5years) than the CA-dominant group(CA-BA ≥ 5 years)(P = 0.034). When the subjects were categorized into four groups according to MS and age gap between BA and CA, the incidence of colorectal adenoma increased with MS and BA-dominance(P < 0.05).CONCLUSION Measurement of BA may help to assess the risk of colorectal adenoma in screening colonoscopy.

Fatal rhabdomyolysis and disseminated intravascular coagulation after total knee arthroplasty under spinal anesthesia:A case report

BACKGROUND Rhabdomyolysis develops as a result of skeletal muscle cell collapse from leakage of the intracellular contents into circulation.In severe cases,it can be associated with acute kidney injury and disseminated intravascular coagulation,leading to life threatening outcomes.Rhabdomyolysis can occur in the perioperative period from various etiologies but is rarely induced by tourniquet use during orthopedic surgery.CASE SUMMARY A 77-year-old male underwent right total knee arthroplasty using a tourniquet under spinal anesthesia.About 24 h after surgery,he was found in a drowsy mental state and manifested features of severe rhabdomyolysis,including fever,hypotension,oliguria,high creatine kinase,myoglobinuria,and disseminated intravascular coagulation.Despite supportive care,cardiac arrest developed abruptly,and the patient was not able to be resuscitated.CONCLUSION Severe rhabdomyolysis and disseminated intravascular coagulation can develop from surgical tourniquet,requiring prompt,aggressive treatments to save the patient.

Massive hemothorax following internal jugular vein catheterization under ultrasound guidance:A case report

BACKGROUND Hemothorax is a rare but life-threatening complication of central venous catheterization.Recent reports suggest that ultrasound guidance may reduce complications however,it does not guarantee safety CASE SUMMARY A 75-year-old male patient was admitted for laparoscopic radical nephrectomy.Under ultrasound guidance,right internal jugular vein catheterization was successfully achieved after failure to aspirate blood from the catheter in the first attempt.Sudden hypotension developed after surgical positioning and persisted until the end of the operation,lasting for about 4 h.In the recovery room,a massive hemothorax was identified on chest radiography and computed tomography.The patient recovered following chest tube drainage of 1.6 L blood.CONCLUSION Hemothorax must be suspected when unexplained hemodynamic instability develops after central venous catheterization despite ultrasound guidance.So the proper use of ultrasound is important.