Premedication With Single Dose of Acetazolamide for the Control of Referral Shoulder Pain After Laparoscopic Cholecystectomy.

BACKGROUND: The use of laparoscopic surgeries is escalating thanks to their advantages over the open surgeries. However, several complications can be observed following laparoscopy operation. Postoperative pain is a major concern in cholecystectomy surgeries. Pain can be both experienced in operated areas and radiated to the right shoulder. Acetazolamide is used for glaucoma, acute mountain sickness prophylaxis, and epilepsy in few patients with recurrent epilepsy. It seems that patients' pain can be reduced by preventing carbonic acid production in abdomen after operation. OBJECTIVES: We aimed at evaluating if administration of acetazolamide preoperatively could affect early or late postoperative pain following laparoscopic surgery. PATIENTS AND METHODS: In a randomized-controlled clinical trial study, 70 subjects (30 - 60 years) scheduled for laparoscopic cholecystectomy were included after obtaining a written informed consent. Patients were divided into two groups randomly (intervention and control). The intervention group received 5 mg/kg oral acetazolamide one hour before the operation. The control group did not receive any further medication. RESULTS: Administration of a single dose of acetazolamide did not have any statistically significant impact on sleep quality (P = 1.000). Moreover, there was no statistically significant difference between groups regarding nausea and vomiting on single dose administration of acetazolamide (P = 1.000). Single dose of acetazolamide was associated with statistically significant decrease in shoulder pain immediately after laparoscopy (P = 0.017). However, there was no statistically significant difference regarding shoulder pain between the studied groups 2, 4, 6, 8, 10, 12, and 24 hours after laparoscopy. Single dose of acetazolamide did not significantly affect analgesic administration in 2, 4, 6, 8, 10, 12, and 24 hours after laparoscopy. CONCLUSIONS: Single dose of acetazolamide was associated with statistically significant decrease in shoulder pain immediately after laparoscopy. However, this effect was limited to the first postoperative hours and it failed to reduce postoperative pain of right shoulder during 24 hours after the operation.

Histopathological and molecular study of Neospora caninum infection in bovine aborted fetuses

To estimate the extent to which abortion in dairy cows was associated with of Neospora caninum (N. caninum) and to determine the risk factors of neosporosis in dairy farms from 9 provinces in Iran. Methods: Polymerase chain reaction (PCR) test was used to detect Neospora infection in the brain of 395 bovine aborted fetuses from 9 provinces of Iran. In addition, the brains of aborted fetuses were taken for histopathological examination. To identify the risk factors associated with neosporosis, data analysis was performed by SAS. Results: N. caninum was detected in 179 (45%) out of 395 fetal brain samples of bovine aborted fetuses using PCR. Among the PCR-positive brain samples, only 56 samples were suited for histopathological examination. The characteristic lesions of Neospora infection including non-suppurative encephalitis were found in 16 (28%) of PCR-positive samples. The risk factors including season, parity of dam, history of bovine virus diarrhea and infectious bovine rhinotracheitis infection in herd, cow’s milk production, herd size and fetal appearance did not show association with the infection. This study showed that Neospora caused abortion was significantly more in the second trimester of pregnancy than other periods. In addition, a significant association was observed between Neospora infection and stillbirth. Conclusions: The results showed N. caninum infection was detected in high percentage of aborted fetuses. In addition, at least one fourth of abortions caused by Neospora infection. These results indicate increasing number of abortions associated with the protozoa more than reported before in Iran.

Multimodal preincisional premedication to prevent acute pain after cholecystectomy.

INTRODUCTION: Postoperative pain as an important medical concern is usually treated by opioids which also are of various inevitable side effects. The aim of this study was to assess the efficacy of multimodal preincisional premedication on preventing post-cholecystectomy acute pain. METHODS: In a randomized clinical trial, sixty patients undergoing open cholecystectomy were randomized into two groups. Before anesthesia induction, Diclofenac suppository (100 mg) and oral Clonidine (0.2 mg) were administered in the first group. Immediately before operation, patients received Ketamine (1 mg/kg IV) while the control group received placebo. The site of incision was infiltrated by the surgeon with 20 mL Bupivacaine 0.25% in both groups. Anesthesia induction and maintenance were similar in both groups. The severity of pain was recorded 2, 4, 6, 12, 24 and 48 hours after operation according to Visual Analogue Scale. RESULTS: The severity of pain at two defined stages (6 and 12 hours later) was significantly less in the intervention group than the control group (P<0.005). The average pain severity score was less than the control group (P<0.005). CONCLUSION: In our study, the administration of Clonidine, Diclofenac and Ketamine and bupivacaine infiltration to the site of incision, altogether was associated with a significant decrease in pain score and opioid requirement after cholecystectomy in comparison to bupivacaine infiltration to the site of incision.