Do we still need to restrict preoperative fluid administration in ambulatory anorectal surgery under spinal anaesthesia?

BACKGROUND: This study was undertaken to determine the effect of a restricted versus a standard intravenous fluid regimen on urinary retention and readiness for discharge after surgery for benign anorectal disease. METHODS: A total of 41 ASA I-II patients were randomized into a standard fluid regimen group (group S, n=21) or a restricted fluid regimen group (group R, n=20). Spinal anaesthesia was performed with hyperbaric ropivacaine. Haemodynamic variables were noted. Hypotension, headache, analgesia requirement, nausea and vomiting, thirst and urinary retention were evaluated postoperatively. The Mann-Whitney U and chi-squared tests were used. RESULTS: Patient demographics were comparable between the groups. The area under heart rate versus time curve was higher in group R than in group S (p=0.002). Additional fluid and ephedrine requirements were similar between the groups. First voiding time was longer in group R (p=0.045). CONCLUSION: In minor anorectal surgery under spinal anaesthesia with ropivacaine, standard fluid regimen provides stable haemodynamic variables without urinary retention.

Preoperative use of selective COX-II inhibitors for pain management in laparoscopic nissen fundoplication.

BACKGROUND: This randomized, double-blind, prospective, placebo controlled study was planned to determine the effectiveness of selective COX-II inhibitors used preoperatively to alleviate pain after Nissen fundoplication surgery. METHODS: For this study, 60 patients were allocated to four groups at random: group C (celecoxib, 200 mg by mouth), group R (rofecoxib, 50 mg by mouth), group P (placebo, pill), or group D (diclophenac sodium, 75 mg intramuscularly). Postoperative abdominal and shoulder pain experienced by the patient at rest, with motion, and with coughing were assessed. Side effects and postoperative analgesic requirement (tramadol, intramuscular) also were recorded. RESULTS: The median tramadol requirement in the 1st h and total tramadol requirement at the 24th h were higher in group P than in the other study groups (p < 0.01). The pain scores in the first postoperative hour were higher in group P (p < 0.05). CONCLUSIONS: The preoperative use of celecoxib, rofecoxib, or diclophenac in laparoscopic Nissen fundoplication surgery decreases pain intensity and tramadol requirement in the first postoperative hour and has a trarnadol sparing effect in the first 24 h.