Effect of gender on pain perception and analgesic consumption in laparoscopic cholecystectomy: An observational study.

BACKGROUND: Evidence regarding gender affecting the response to pain and its treatment is inconsistent in literature. The objective of this prospective, observational study was to determine the effect of gender on pain perception and postoperative analgesic consumption in patients undergoing laparoscopic cholecystectomy. MATERIALS AND METHODS: We recruited 60 male and 60 female patients undergoing elective laparoscopic cholecystectomy. Patients were observed for additional intraoperative and postoperative analgesia. Numerical rating scale was documented at 10 min interval for 1 h in post-anesthesia recovery room and at 4, 8, and 12 h postoperatively. Boluses of tramadol given as rescue analgesia were also noted. There were no dropouts. RESULTS: The mean pain scores were significantly higher in female patients at 20 and 30 min following surgery. Mean dose of tramadol consumption was significantly higher in female patients for the first postoperative hour (P = 0.002), but not in the later period. CONCLUSION: Female patients exhibited greater intensity of pain and required higher doses of analgesics compared to males in in the immediate postoperative period in order to achieve a similar degree of analgesia.

Knowledge about Pain Clinics and Pain Physician among General Practitioners: A Cross-sectional Survey.

INTRODUCTION: There is an on-going debate about what qualifies one to be called a "pain physician" and who can run the "pain clinic". Currently, the discipline of anesthesiology is producing the majority of pain physicians. A literature search was unable to find data for any Pakistani or other South Asian countries with regards to general practitioner (GP) knowledge about pain clinics and pain physicians. The main objective of this study was to assess the awareness of GPs regarding the existence of the pain clinic and pain physician. METHODS: A total of 411 GPs were included in this cross-sectional survey. A questionnaire consisting of ten questions was designed to identify their knowledge about the existence of pain clinics and pain physicians. Questionnaires were completed in the field and edited for the inconsistencies and in-completeness. RESULTS: The results showed that only 52.6% of GPs were aware of the existence of pain clinics. The survey showed that 37.5% believe neurologists are the pain physicians and only 10.9% know that pain clinics are run by anesthesiologist. The vast majority (85.0%) are unaware of the modern pain relieving methods used in pain clinics. CONCLUSION: The survey indicates that nearly half of the GPs are unaware of the existence of pain clinics and pain physicians, and the majority of GPs are unaware of new pain relieving methods.

Adequacy of postoperative pain relief after discharge.

Day care surgery has shown a remarkable development over the last two decades, comprising approximately 60-70% of all surgical procedures. Therefore major proportions of surgical patients are recovering at home and have little or no assessment of the adequacy of their pain relief. The aim of our audit was to compare suggested postoperative pain indicators with targets for best practice. This audit was done at the Aga Khan University Hospital day care unit for a period of three months. On the day of surgery patients having the contact numbers were informed about the telephone call 24 hrs after the surgery inquiring about their pain relief. Patients were shown and explained the visual analogue score from 0 to 10. The data was collected by one of the investigators on the day of surgery. We could assess 63.3% of day care patients. All patients were discharged with analgesia. Only three percent reported severe pain after 24 hrs which is according to the proposed standard for best practice that is < 5%. Sixty percent of patients had mild or no pain which is less than the proposed standard (> 85%) and 84.2% were satisfied which is almost borderline (> 85%) according to the standard of best practice.

General anaesthesia for emergency caesarian section in a patient with Eisenmenger's syndrome and pre-eclampsia.

Pregnancy is poorly tolerated in patients with Eisenmenger syndrome (ES) with maternal mortality of 30-50%. Physiological changes of pregnancy decreases systemic vascular resistance that further aggravates the bi-directional or right to left shunt associated with ES. When it occurs with eclampsia, the morbidity and mortality are even higher. We report a case of 30 weeks pregnant woman with ES, who underwent emergency caesarian section because of pre-eclampsia. The intra-operative course was uneventful but she died on the second post-operative day. Post-operatively she was managed by the cardiologist in the coronary care unit. The probable cause being that she was over transfused, as the fluid status was not assessed by any invasive monitoring (like CVP). It was concluded that patients should be monitored closely in the post-operative period in the intensive care unit with complete invasive monitoring for up to a week to prevent factors resulting in worsening of the shunt (such as fluid balance) and thromboembolic phenomenon.