Effect of transcutaneous electrical acupoint stimulation based on the theory of "qi ascending and descending movement" on autonomic nervous system and gastrointestinal function in patients after general anesthesia laparoscopic cholecystectomy. / 基于"气机升降"ç†è®ºç»çš®ç©´ä½ç”µåˆºæ¿€å¯¹å ¨éº»è ¹è ”é•œèƒ†å›Šåˆ‡é™¤æœ¯åŽæ‚£è€ è‡ªä¸»ç¥žç»å’Œèƒƒè‚ åŠŸèƒ½çš„å½±å“.

OBJECTIVES: To observe the therapeutic effect of transcutaneous electrical acupoint stimulation (TEAS) based on the theory of "qi ascending and descending movement" in patients after general anesthesia laparoscopic cholecystectomy, so as to explore the impact of TEAS on the autonomic nervous system and gastrointestinal function of patients. METHODS: A total of 204 patients scheduled to undergo general anesthesia laparoscopic cholecystectomy were selected and randomly divided into control, double acupoints and multiple acupoints groups, with 68 cases in each group. For patients in the multiple acupoints group, TEAS was applied at Zusanli (ST36), Tiantu (CV22), Danzhong (CV17), Zhongwan (CV12), Taichong (LR3), and Neiguan (PC6) 30 min before anesthesia induction until the end of the surgery. In the double acupoints group, TEAS was applied only at ST36 and PC6. No electrical stimulation was applied in the control group. The postoperative bloating, bowel sound recovery time, first farting time, first defecation time, length of hospital stay, nausea and vomiting were compared among the three groups. Heart rate variability was monitored by twelve-lead electrocardiogram to evaluate the autonomic nervous function of the patients, including the low frequency power/high frequency power ratio (LF/HF), the standard deviation of all sinus RR intervals (SDNN), and the root mean square of difference between successive normal RR intervals (RMSSD). RESULTS: At 6 h and 24 h after surgery, the symptoms of bloating, nausea and vomiting in the multiple acupoints group and double acupoints group were significantly improved compared to the control group (P<0.05), and the multiple acupoints group was superior to the double acupoints group (P<0.05). Compared with the control group, the bowel sound recovery time, first farting time, first defecation time, and length of hospital stay were significantly shorter (P<0.05) in the multiple acupoints group and double acupoints group, and the multiple acupoints group was superior to the double acupoints group (P<0.05). At 1 d and 2 d after surgery, compared with the control group, LF/HF was decreased (P<0.05) while SDNN and RMSSD were increased (P<0.05) in the multiple acupoints group and double acupoints group, and there was a significant difference between the two groups (P<0.05). CONCLUSIONS: TEAS treatment based on the theory of "qi ascending and descending movement" can relieve gastrointestinal dysfunction, reduce early postoperative sympathetic nerve excitement and maintain parasympathetic nerve tension in patients after general anesthesia laparoscopic cholecystectomy, thereby promoting gastrointestinal function recovery.

The Efficacy of Acupressure for Nausea and Vomiting After Laparoscopic Cholecystectomy: A Meta-analysis Study.

OBJECTIVES: This meta-analysis aims to explore the impact of acupressure on nausea and vomiting for patients undergoing laparoscopic cholecystectomy (LC). BACKGROUND: Acupressure may have some potential in managing nausea and vomiting after LC. PATIENTS AND METHODS: PubMed, Embase, Web of Science, EBSCO, and Cochrane library databases were systematically searched, and we included randomized controlled trials assessing the effect of acupressure on nausea and vomiting for LC. RESULTS: Six randomized controlled trials were finally included in the meta-analysis. Overall, compared with control intervention for LC, acupressure was associated with significantly reduced incidence of nausea at 2 hours [odds ratio (OR) = 0.37; 95% CI = 0.21-0.67; P = 0.001] and nausea at 6 hours (OR = 0.38; 95% CI = 0.22-0.66; P = 0.0006; Fig. 4), and decreased need of rescue antiemetic (OR = 0.41; 95% CI = 0.20-0.85; P = 0.02; Fig. 8), but demonstrated no obvious impact on vomiting at 2 hours (OR = 0.76; 95% CI = 0.28-2.10; P = 0.60), vomiting at 6 hours (OR = 0.49, 95% CI = 0.20-1.20; P = 0.12), nausea at 24 hours (OR = 0.71; 95% CI = 0.37-1.35; P = 0.30), or vomiting at 24 hours (OR = 0.81; 95% CI = 0.28-2.35; P = 0.69). CONCLUSIONS: Acupressure is effective in controlling nausea and decreasing rescue antiemetics for LC.

Comparison of the effects of ampulla-guided realignment and conventional gallbladder triangle anatomy in difficult laparoscopic cholecystectomy.

OBJECTIVE: To compare the effects of ampulla-guided realignment and conventional gallbladder triangle anatomy in difficult laparoscopic cholecystectomy (DLC). METHODS: From June 2021 to August 2022, data from 100 patients undergoing DLC at Nanjing Hospital of Traditional Chinese Medicine were analyzed retrospectively. Patients were divided into two groups: the experimental group (LC with the ampulla-guided realignment) and the control group (conventional LC with triangular gallbladder anatomy), with 50 patients per group. The intraoperative blood loss, operation time, postoperative drainage tube indwelling time, hospitalization time, bile duct injury rate, operation conversion rate, and incidence of postoperative complications were recorded and compared between the two groups. The pain response and daily activities of the patients in the two groups were evaluated 48 h after the operation. RESULTS: The amount of intraoperative blood loss, postoperative drainage tube indwelling time, hospital stay, operation conversion rate, pain degree at 24 and 48 h after operation, bile duct injury incidence, and total postoperative complication rate were shorter or lower in the experimental group than those in the control group (p < 0.05). The Barthel index scores of both groups were higher 48 h after the operation than before the operation, and the experimental group was higher than the control group (p < 0.05). CONCLUSION: The ampulla-guided alignment in DLC surgery was more beneficial in promoting postoperative recovery, reducing postoperative pain response, reducing the incidence of postoperative complications, and reducing bile duct injury.

Effects of dexmedetomidine on surgical site wound pain in patients undergoing laparoscopic cholecystectomy: A meta-analysis.

This study aimed to evaluate the effectiveness of dexmedetomidine as an adjuvant to local wound infiltration anaesthesia in reducing surgical site wound pain in patients undergoing laparoscopic cholecystectomy. The Cochrane Library, PubMed, EMBASE, China National Knowledge Infrastructure, and Wanfang databases were searched from the time of database creation until February 2023. We performed a randomised controlled trial on the effect of dexmedetomidine as an adjunct to local wound infiltration anaesthesia on postoperative wound pain in patients undergoing laparoscopic cholecystectomy. Two investigators independently screened the literature, extracted data, and evaluated the quality of each study. This study was performed using the Review Manager 5.4 software. Ultimately, 13 publications with 1062 patients were included. The results showed that dexmedetomidine was effective as an adjunct to local wound infiltration anaesthesia at 1 h (standardised mean difference [SMD]: -5.31, 95% confidence intervals [CIs]: -7.22 to -3.40, P < .001), 4 h (SMD: -3.40, P < .001), 12 h (SMD: -2.11, 95% CIs: -3.10 to -1.13, P < .001) and 24 h postoperatively (SMD: -1.98, 95% CIs: -2.76 to -1.21, P < .001) significantly reduced surgical site wound pain. However, there was no significant difference in the analgesic effect at 48 h postoperatively (SMD: -1.33, 95% CIs: -3.25 to -0.58, P = .17). Dexmedetomidine provided good postoperative wound analgesia at the surgical site when used for laparoscopic cholecystectomy.

The Efficacy of Foot Massage for Pain Relief of Laparoscopic Cholecystectomy: A Meta-analysis Study.

BACKGROUND: Foot massage may have some potential in improving pain relief in patients undergoing laparoscopic cholecystectomy, and this meta-analysis aims to explore the impact of foot massage on pain control after laparoscopic cholecystectomy. MATERIALS AND METHODS: PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched, and we included randomized controlled trials assessing the effect of foot massage on pain control after laparoscopic cholecystectomy. RESULTS: Five randomized controlled trials were included in the meta-analysis. Overall, compared with control intervention for laparoscopic cholecystectomy, foot massage was associated with significantly lower pain scores at 60 minutes [mean difference (MD)=-1.19; 95% CI=-2.01 to -0.38; P =0.004), pain scores at 90 minutes (MD=-1.41; 95% CI=-1.73 to -1.10; P <0.00001), pain scores at 120 to 150 minutes (MD=-2.20; 95% CI=-2.49 to -1.90; P <0.00001) and reduced need of additional analgesia (odd ratio=0.04; 95% CI=0.02-0.08; P <0.00001), but demonstrated no obvious effect on pain scores at 10 to 30 minutes (MD=-0.25; 95% CI=-0.79 to 0.29; P =0.37). CONCLUSIONS: Foot massage benefits to improve pain control after laparoscopic cholecystectomy.

Transcutaneous Electrical Acupoints Stimulation Improves Spontaneous Voiding Recovery After Laparoscopic Cholecystectomy: A Randomized Clinical Trial.

BACKGROUND: Facilitating the recurrence of spontaneous voiding is considered to be a way to prevent urinary retention after surgery, which is of great importance in cholecystectomy. This study aimed to assess the effect of transcutaneous electrical acupoint stimulation (TEAS) on spontaneous voiding recovery after laparoscopic cholecystectom. METHODS: Participants who underwent elective laparoscopic cholecystectomy were randomly assigned to either the TEAS group or the sham group. Active TEAS or sham TEAS at specific acupuncture points was conducted intraoperatively and postoperatively. The primary outcome was the recovery speed of spontaneous voiding ability after surgery and secondary outcomes included postoperative urinary retention (POUR), voiding dysfunction, pain, anxiety and depression, and early recovery after surgery. RESULTS: A total of 1,948 participants were recruited and randomized to TEAS (n = 975) or sham (n = 973) between August 2018 and June 2020. TEAS shortens the time delay of the first spontaneous voiding after laparoscopic cholecystectomy (5.6 h [IQR, 3.7-8.1 h] in the TEAS group vs 7.0 h [IQR, 4.7-9.7 h] in the sham group) (p < 0.001). The TEAS group experienced less POUR (p = 0.020), less voiding difficulty (p < 0.001), less anxiety and depression (p < 0.001), reduced pain (p = 0.007), and earlier ambulation (p = 0.01) than the sham group. CONCLUSIONS: Our results showed that TEAS is an effective approach to accelerate the recovery of spontaneous voiding and reduce POUR which facilitates recovery for patients after laparoscopic cholecystectomy.

The Effects of Breathing Exercises on Patients Having Laparoscopic Cholecystectomy Surgery.

The aim of the study is to determine the effect of breathing exercises on patients who underwent laparoscopic cholecystectomy in terms of their level of anxiety, sleep, and recovery of quality after surgery. A randomized, controlled experimental research model was used in this work. This study was conducted in surgery clinic of a university hospital between December 2020 and May 2021. The research was completed with 58 patients in the experimental group and 57 patients in the control group. The mean Visual Analog Sleep Scale and state anxiety score of the patients in the control group was higher in the morning of the operation and on the 1st, 15th, and 30th days after the operation than that of the experimental group patients, and the difference was statistically significant (p < .05). The correlations between recovery quality, state anxiety, and sleep quality on the first postoperative day were significant at (p < .05) in the opposite direction.

Comparing the Effect of Incentive Spirometry and Deep Breathing Exercises on the Level of Shoulder Pain and Nausea Following Laparoscopic Cholecystectomy Surgery: A Clinical Trial Study.

Cholecystitis treated by laparoscopy results in patients experiencing shoulder pain and nausea. Thus, the aim of the present study was to compare the effect of incentive spirometry and deep breathing exercises on the level of shoulder pain and nausea following laparoscopy. In this clinical trial, 105 patients were enrolled into three groups: use of incentive spirometry, deep breathing exercises, and control. Data were collected using a checklist and a visual analog scale and analyzed through the χ2, the Kruskal-Wallis, the Friedman, and the paired t test by SPSS Version 25. In the deep breathing exercise, incentive spirometry, and control groups, mean pain scores immediately after surgery but within 24 hours following the intervention were 3.8, 2.6, and 4.4, respectively. The mean score of severity of nausea for patients in the deep breathing exercise and incentive spirometry groups showed a significant difference immediately after the procedure, as well as at 12 and 24 hours post-intervention. Breathing exercises and incentive spirometry can be effective in reducing pain and nausea in patients undergoing cholecystectomy through laparoscopy. Because of the effectiveness of the two methods, nurses can use incentive spirometery and deep breathing exercises to diminish patients' pain post-cholecystectomy.

Effectiveness Of Local Anaesthetic In Reducing Postoperative Pain At Port Site After Laparoscopic Cholecystectomy.

Background: Laparoscopy has become the highest quality level way to deal with cholecystectomy since its inception 30 years preceding, and is perhaps the most normally performed general surgeries. Pain being a significant issue after laparoscopic cholecystectomy bringing about extended admissions or readmissions. With significant varieties in pain relieving conventions an integrated approach is important to diminish pain. The aim of this study is to assess the effectiveness of Bupivacaine as local anesthetic agent at port sites after laparoscopic cholecystectomy. Method: Study population of 84 patients was divided into control group (receiving no local anesthetic) and study group (receiving Bupivacaine as local anesthetic). Visual analogue scale was used to quantify and compare pain perceived by each group; at fixed intervals of 6, 12 and 24 hours after shifting of the patients back to the ward. Results: Each group comprised 42 patients. At 6 hours post operative pain score in study group, 4.5±0.32 was significantly lower than in control group, 7.6±0.41 (p<0.05). Though pain assessments at 12 and 24 hours didn't reveal any significant differences among the two groups; postoperative requirement of Tramadol was significantly (p<0.05) lower in study group (92±0.064mg) in comparison to control group (158±0.21mg). Conclusion: Use of long-acting local anesthetic injections at port sites after laparoscopic cholecystectomy significantly lowers pain during first 6 hours post operatively and also lowers narcotic analgesics requirements during post operative period.

Effect of Guided Imagery Meditation During Laparoscopic Cholecystectomy on Reducing Anxiety: A Randomized Controlled Trial.

BACKGROUND: Up to 90% of patients still experience pain after abdominal surgery, which also affects their physical recovery and psychological anxiety. AIM: To evaluate the effects of guided imagery meditation on ameliorating anxiety, improving the quality of sleep, and relieving postoperative pain in patients after laparoscopic cholecystectomy surgery. METHOD: In the general surgical ward of a teaching hospital, patients were randomly assigned to usual care (n = 34) and guided imagery meditation intervention (n = 34) groups, using the method. The measuring outcomes included their anxiety score, quality of sleep, and pain control. RESULTS: In terms of the anxiety difference, the experimental group scored 0.42 (standard deviation [SD] = 0.97), while the control group scored 4.79 (SD = 7.56), which indicates a statistically significant difference (F = 8.04, p = .01, partial eta2 = 0.11). In terms of quality of sleep, the mean score of the experimental group was 2.67 (SD = 1.96), while the control group scored 7.55 (SD = 3.81), which indicates a significant difference (F = 39.99, p = .001, partial eta2 = 0.39). The mean of the degree of postoperative pain was 2.11 points (SD = 1.39), and the score of the control group was 4.00 points (SD = 1.62), which indicates a significant difference (p = .001). CONCLUSIONS: Guided imagery meditation is a simple, non-invasive, non-pharmacologic intervention measure. It can reduce anxiety and postoperative pain, and improve the quality of sleep. Thus, it should be promoted in clinical practice.

[Effect of electroacupuncture on gastrointestinal function of patients after laparoscopic cholecystectomy under general anesthesia].

OBJECTIVE: To observe the effects of electroacupuncture at bilateral Zusanli(ST36), Shangjuxu(ST37), and Sanyinjiao (SP6) acupoints on gastrointestinal function after laparoscopic cholecystectomy under general anesthesia. METHODS: A total of 150 patients(American Society of Anesthesiologists［ASA］ grades Ⅰ and Ⅱ) undergoing laparoscopic cholecystectomy in the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Guangzhou University of Chinese Medicine were randomly assigned into three groups: electroacupuncture group (n=50), simple acupuncture group (n=50), and control group (n=50). Patients in the control group received routine treatment；on the basis of routine treatment, patients in the simple acupuncture group were acupunctured at bilateral ST36, ST37 and SP36；patients in the electroacupuncture group were treated with electroacupuncture at bilateral ST36, ST37 and SP36（50 Hz，5 mA）. In both simple acupuncture group and electroacupuncture group, the corresponding treatments were conducted 1 h after surgery, Patients as well as in the morning (8:00-10:00) and afternoon (14:00-16:00) on the first day after surgery, 30 min each time. The time of bowel sound recovery, the time to the first postope-rative exhaust and defecation, the time of postoperative fluid diet recovery, abdominal pain score, and gastrointestinal reaction score were recorded and analyzed. RESULTS: Compared with the control group, the electroacupuncture group and the simple acupuncture group showed shortened time of bowel sound recovery, shortened time to the first postoperative exhaust and defecation, and shortened time of postoperative liquid diet recovery (P<0.01), as well as decreased postoperative abdominal pain score and gastrointestinal reaction score (P<0.01). Furthermore, the time of bowel sound recovery, the time to the first postoperative exhaust and defecation, and the time of postoperative liquid diet recovery were shortened in the electroacupuncture group compared with those in the simple acupuncture group (P<0.01). The total effective rate of electroacupuncture group was 94.0% (47/50), the total effective rate of simple acupuncture group was 88.0% (44/50), significantly higher than 78.0% (39/50) in the control group (P<0.05). CONCLUSION: Both electroacupuncture and simple acupuncture can promote the recovery of gastrointestinal function in patients after laparoscopic cholecystectomy under general anesthesia, and electroacupuncture is superior to simple acupuncture,but they have no significant difference in alleviating postoperative abdominal pain and gastrointestinal reactions.

THE USE OF MICROBIOLOGICAL AND LABORATORY DATA IN THE CHOICE OF EMPIRICAL ANTIBIOTIC THERAPY IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY - THE ROLE OF LOCAL ANTIBIOGRAMS.

Antibiotic therapy is indicated during acute cholecystitis. However, in the treatment of uncomplicated cholelithiasis, prophylactic use of antibiotics is controversial. Microbiological and laboratory data are the basis for the choice of antibiotic treatment. However, monitoring and updating local antibiograms is important because they ensure effective therapy in the given clinical environment. The study included 110 consecutive patients who underwent laparoscopic cholecystectomy, divided into the group of uncomplicated cholelithiasis (n=60) and the group of acute cholecystitis (n=50). Preoperative data included age, sex, body mass index, leukocytes, C-reactive protein, and ultrasound examination. Bile samples for bacteriological testing were obtained under aseptic conditions during the surgery. Cultures were evaluated for aerobic, anaerobic and fungal organisms using routine tests. After the surgery, gallbladder specimens were sent for histopathological examination. In the group of uncomplicated cholelithiasis, 6/60 positive samples were found, and in the group of acute cholecystitis, there were 25/50 positive microbiological findings. Citrobacter sp. and Enterococcus faecalis predominated in the group of uncomplicated cholelithiasis, and Escherichia coli, Enterococcus faecalis, Proteus mirabilis and Citrobacter sp. in the group of acute cholecystitis. Antibiotics were administered to 49/50 patients with acute cholecystitis and to 32/60 patients with uncomplicated cholelithiasis. Cefazolin was the most frequently used antibiotic and also the most resistant antibiotic. To conclude, the administration of antibiotics in elective patients is not justified. The results of this study indicate that third-generation cephalosporin or ciprofloxacin + metronidazole should be administered in mild and moderate acute cholecystitis, and fourth-generation cephalosporin + metronidazole in severe acute cholecystitis in this local setting. The appropriate use of antibiotic agents is crucial and should be integrated into good clinical practice and standards of care.

Intraperitoneal local anaesthetic instillation versus no intraperitoneal local anaesthetic instillation for laparoscopic cholecystectomy.

BACKGROUND: Pain is one of the important reasons for delayed discharge after laparoscopic cholecystectomy. Use of intraperitoneal local anaesthetic for laparoscopic cholecystectomy may be a way of reducing pain. A previous version of this Cochrane Review found very low-certainty evidence on the benefits and harms of the intervention. OBJECTIVES: To assess the benefits and harms of intraperitoneal instillation of local anaesthetic agents in people undergoing laparoscopic cholecystectomy. SEARCH METHODS: We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and three other databases to 19 January 2021 together with reference checking of studies retrieved. We also searched five online clinical trials registries to identify unpublished or ongoing trials to 10 September 2021. We contacted study authors to identify additional studies. SELECTION CRITERIA: We only considered randomised clinical trials (irrespective of language, blinding, publication status, or relevance of outcome measure) comparing local anaesthetic intraperitoneal instillation versus placebo, no intervention, or inactive control during laparoscopic cholecystectomy, for the review. We excluded non-randomised studies, and studies where the method of allocating participants to a treatment was not strictly random (e.g. date of birth, hospital record number, or alternation). DATA COLLECTION AND ANALYSIS: Two review authors collected the data independently. Primary outcomes included all-cause mortality, serious adverse events, and quality of life. Secondary outcomes included length of stay, pain, return to activity and work, and non-serious adverse events. The analysis included both fixed-effect and random-effects models using RevManWeb. We performed subgroup, sensitivity, and meta-regression analyses. For each outcome, we calculated the risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CIs). We assessed risk of bias using predefined domains, graded the certainty of the evidence using GRADE, and presented outcome results in a summary of findings table. MAIN RESULTS: Eighty-five completed trials were included, of which 76 trials contributed data to one or more of the outcomes. This included a total of 4957 participants randomised to intraperitoneal local anaesthetic instillation (2803 participants) and control (2154 participants). Most trials only included participants undergoing elective laparoscopic cholecystectomy and those who were at low anaesthetic risk (ASA I and II). The most commonly used local anaesthetic agent was bupivacaine. Methods of instilling the local anaesthetic varied considerably between trials; this included location and timing of application. The control groups received 0.9% normal saline (69 trials), no intervention (six trials), or sterile water (two trials). One trial did not specify the control agent used. None of the trials provided information on follow-up beyond point of discharge from hospital. Only two trials were at low risk of bias. Seven trials received external funding, of these three were assessed to be at risk of conflicts of interest, a further 17 trials declared no funding. We are very uncertain about the effect intraperitoneal local anaesthetic versus control on mortality; zero mortalities in either group (8 trials; 446 participants; very low-certainty evidence); serious adverse events (RR 1.07; 95% CI 0.49 to 2.34); 13 trials; 988 participants; discharge on same day of surgery (RR 1.43; 95% CI 0.64 to 3.20; 3 trials; 242 participants; very low-certainty evidence). We found that intraperitoneal local anaesthetic probably results in a small reduction in length of hospital stay (MD -0.10 days; 95% CI -0.18 to -0.01; 12 trials; 936 participants; moderate-certainty evidence). No trials reported data on health-related quality of life, return to normal activity or return to work. Pain scores, as measured by visual analogue scale (VAS), were lower in the intraperitoneal local anaesthetic instillation group compared to the control group at both four to eight hours (MD -0.99 cm VAS; 95% CI -1.19 to -0.79; 57 trials; 4046 participants; low-certainty of evidence) and nine to 24 hours (MD -0.68 cm VAS; 95% CI -0.88 to -0.49; 52 trials; 3588 participants; low-certainty of evidence). In addition, we found two trials that were still ongoing, and one trial that was completed but with no published results. All three trials are registered on the WHO trial register. AUTHORS' CONCLUSIONS: We are very uncertain about the effect estimate of intraperitoneal local anaesthetic for laparoscopic cholecystectomy on all-cause mortality, serious adverse events, and proportion of patients discharged on the same day of surgery because the certainty of evidence was very low. Due to inadequate reporting, we cannot exclude an increase in adverse events. We found that intraperitoneal local anaesthetic probably results in a small reduction in length of stay in hospital after surgery. We found that intraperitoneal local anaesthetic may reduce pain at up to 24 hours for low-risk patients undergoing laparoscopic cholecystectomy. Future randomised clinical trials should be at low risk of systematic and random errors, should fully report mortality and side effects, and should focus on clinical outcomes such as quality of life.

Increasing use of intraoperative cholangiogram in Australia: is it evidence-based?

BACKGROUND: The role of routine intraoperative cholangiograms (IOCs) for prevention of bile duct injury (BDI) is contentious. There are recent reports of limited utility of IOC in preventing BDI. In Australia, IOCs are used more frequently than internationally. This study aimed to evaluate the rate of IOC use in Australia and explore potential changes in practice in light of evolving evidence for the utility of IOC. METHODS: Data were collated using service item numbers in Medicare Benefits Scheme records on the Australian Government Medicare website, for services claimed between 1 January 2001 and 31 December 2019. These data were used to analyse trends in rates of IOC, cholecystectomy and BDI repair. Data were age-standardized to account for changes in the population over time. RESULTS: The number of IOCs claimed increased by 31.8% and cholecystectomies by 7.0% over the study period. Age-standardized service rates per 100 000 persons increased by 5.5 and 32.6, respectively. Rates of IOC per 100 000 cholecystectomies steadily increased across the study period, while BDI repair rates remained low and erratic. CONCLUSION: Increasing use of IOC over the last 20 years reflects a trend towards routine rather than selective IOC; however, there is little discernible change in the number of BDIs requiring repair procedures. This suggests that routine IOC use to prevent or minimize BDI is unwarranted. Further investigation is required into the selective IOC use in high-risk patients rather than mandatory use in all patients.

The effect of Acupressure and Reiki application on Patient's pain and comfort level after laparoscopic cholecystectomy: A randomized controlled trial.

BACKGROUND: The aim of the study was to examine the effect of Acupressure and Reiki application on patient's pain and comfort level after Laparoscopic cholecystectomy. MATERIALS AND METHODS: In this prospective, single blinded randomized controlled trial, subjects were 132 adult patients, hospitalized in the General Surgery clinics and underwent laparoscopic cholecystectomy of a Training and Research Hospital in Turkey. Subjects were then assigned including a Reiki group of 44 persons, an Acupressure group of 44 persons, and a control group of 44 persons. The pain and comfort levels of all the patients, before and after the Acupressure and Reiki treatments in the experimental group, and without any intervention in the control groups were determined at the 3rd postoperative hour, using Pain on Visual Analogue Scale (Pain on VAS), Perianesthesia Comfort Scale (PCS) and General Comfort Questionnaire (GCQ). The data analyses were performed using descriptive statistics, Shapiro Wilk test, paired samples t-test, Mann Whitney U test, ANOVA and LSD multiple comparison tests, Kruskal Wallis test and Wilcoxon test. RESULTS: In the patients who received reiki and acupressure treatment, the pain level decreased, comfort level increased and the difference between the groups was found to be significant (p < 0.05). CONCLUSION: Reiki and Acupressure applied to the patients after Laparoscopic cholecystectomy decreased the pain and increased the comfort level.

The effect on gastrointestinal system functions, pain and anxiety of acupressure applied following laparoscopic cholecystectomy operation: A randomised, placebo-controlled study.

The aim of this randomised, placebo-controlled, 3-way blinded study was to determine the effect on GIS symptoms, pain and anxiety of acupressure applied for a total of 12 min, as 3 min at each of the ST25, CV12, TH6, and HT7 acupuncture points, at 0, 4 and 8 h after laparoscopic cholecystectomy operation. The research data were collected using a patient data collection form, the Numeric Pain Intensity Scale and the State-Trait Anxiety Inventory. The patients were evaluated in respect of the time to first flatus and defecation, pain and the State-Trait Anxiety points at 0, 4, and 8 h postoperatively. The application of acupressure was determined to have signficantly reduced acute postoperative pain and shortened the time to defecation (p < 0.05). The application of acupressure can be recommended in the nursing interventions following laparoscopic cholecystectomy to reduce acute pain and shorten the time to defecation.

The Effect of Preoperative Oral Versus Parenteral Dextrose Supplementation on Pain, Nausea, and Quality of Recovery After Laparoscopic Cholecystectomy.

PURPOSE: Earlier studies suggest that carbohydrate loading is effective in reducing preoperative nausea. This study was conducted to investigate the effect of preoperative oral versus parenteral carbohydrate loading on the postoperative pain, nausea, and quality of recovery (QoR). DESIGN: Three-arm randomized, single-blind clinical trial. METHODS: In this study, 95 adult patients scheduled for elective laparoscopic cholecystectomy were randomly assigned into three groups of preoperative intravenous dextrose 10% infusion, oral carbohydrate (OCH)-rich drink, and control. The pain and nausea severity scores were measured during recovery, 6 hours, and 24 hours thereafter. The 40-item QoR score was evaluated the day after surgery. FINDINGS: In recovery, nausea severity was comparable among three groups, whereas pain score in the OCH group was significantly less than the controls (P = .009). Pain score in patients who received intravenous dextrose was mediocre and not statistically different from two other groups. Six and 24 hours after surgery, nausea and pain scores in OCH and dextrose infusion groups were significantly lower than the control group (P < .05). The 40-item QoR score was significantly higher in intervention groups than control participants (P < .05). Blood glucose levels were comparable in three groups before and after surgery. CONCLUSIONS: Preoperative carbohydrate loading significantly improves the QoR after laparoscopic cholecystectomy without significant effect on blood glucose levels. Oral route more effectively controls nausea and pain than parenteral dextrose administration.