Anil Agarwal

Postoperative sore throat (POST) contributes to postoperative morbidity. Licorice has been used as an expectorant in cough and cold preparations. In this study, we evaluated the efficacy of licorice gargle for attenuating POST. Forty adults (18-60 yr), ASA physical status I and II of either sex, undergoing elective lumber laminectomy were randomized into two groups of 20 each. Group C: received water; Group L: received 0.5 g licorice in water. Both groups received a 30 mL mixture for 30 s, 5 min before anesthesia which was standardized. The incidence and severity of POST at rest and on swallowing and side effects were assessed at 0, 2, 4, and 24 h, postoperatively. Severity of POST was assessed by visual analog scale (between 0 and 100 mm; where 0 means no sore throat and 100 means worst imaginable sore throat). Postextubation cough was assessed immediately after tracheal extubation. Data were analyzed by Z test and Fisher's exact test. P < 0.05 was considered as significant. POST (incidence and severity) was reduced in the Group L compared with Group C at rest and on swallowing for all time points (P < 0.05), except that the severity of POST at rest, at 24 h, was similar in both groups (P > 0.05). Postextubation cough was reduced in Group L compared with Group C (P < 0.05). There was no difference in side effects between groups (P > 0.05). Licorice gargle performed 5 min before anesthesia is effective in attenuating the incidence and severity of POST.

Postoperative pain is the dominating complaint and the primary reason for prolonged convalescence after laparoscopic cholecystectomy. We have evaluated the efficacy of a single preoperative dose of pregabalin for attenuating postoperative pain and fentanyl consumption after laparoscopic cholecystectomy. Sixty adults (16-60 yr), ASA physical status I and II, of either sex undergoing elective laparoscopic cholecystectomy were included in this prospective, randomized placebo controlled, double-blind study. Subjects were divided into two groups of 30 each to receive either a matching placebo or pregabalin 150 mg, administered orally 1 h before surgery. Postoperative pain (static and dynamic) was assessed by a 100 mm visual analogue scale, where 0, no pain; 100, worst imaginable pain. Subjects received patient-controlled i.v. fentanyl analgesia during the postoperative period. Results were analysed by Student's t-test, chi(2) test, Mann-Whitney U-test, and Fisher's exact test. Postoperative pain (static and dynamic) and postoperative patient-controlled fentanyl consumption were reduced in the pregabalin group compared with the placebo group (P<0.05). Side-effects were similar in both groups. A single preoperative oral dose of pregabalin 150 mg is an effective method for reducing postoperative pain and fentanyl consumption in patients undergoing laparoscopic cholecystectomy.

Catheter-related bladder discomfort (CRBD) is defined as an urge to void or discomfort in the supra-pubic region; reported postoperatively in patients who have had urinary catheterization intra-operatively. We have evaluated tramadol, a centrally acting opioid analgesic with muscarinic receptor antagonist properties for prevention of CRBD. Fifty-four adults (18–60 yr), ASA physical status I and II of either sex, undergoing elective percutaneous nephro-lithomy were randomly divided into two groups of 27 each. Control (C) group received normal saline (NS; 2 ml), whereas Tramadol (T) group received tramadol 1.5 mg kg⁻¹. All medications were diluted in 2 ml NS and administered 30 min before extubation. Intra-operatively, urinary catherization was performed with a 16 Fr Foley's catheter, and the balloon was inflated with 10 ml distilled water. The CRBD was assessed at 0, 1, 2, and 6 h after patient's arrival in the post-anaesthesia care unit along with total postoperative fentanyl requirement. Severity of CRBD was graded as none, mild, moderate and severe. Data were analysed by one-way anova, Z-test, and Fisher's exact test. PP−1) was also reduced in the T group [176 (sd 26.5)] compared with C group [210 (34.6)] (P−1 administered i.v. 30 min before extubation decreases the incidence and severity of CRBD and postoperative fentanyl requirement.

Editor—We compliment Tauzin-Fin and colleagues¹ for recording the severity of catheter-related bladder discomfort (CRBD) on a numerical scale rather than the subjective analysis of previous authors.^2–4 However, they recorded postoperative discomfort in the supra-pubic region as incisional pain contrary to established norm of treating this symptom as manifestation of CRBD. It would have been better if the authors had excluded patients undergoing supra-pubic surgery and thus avoided the confusion regarding the differentiation of postoperative pain and CRBD. They collectively assessed CRBD and postoperative pain with a single VAS scale, but these are two different entities and thus should be assessed on separate scales.

Venous cannulation is often performed without any analgesia, even though pain experienced during this procedure is at times very distressing. Various pharmacological and nonpharmacological measures have been tried with variable results to minimize venous cannulation pain. We designed the present study to evaluate the efficacy of a flash of light on attenuating venous cannulation pain. Ninety adults (15-60 yr), ASA physical status I and II, of either sex, undergoing elective laparoscopic cholecystectomy, were included in this prospective and randomized study. Patients were divided into three groups of 30 each. Group I (control); Group II (distraction): photographed without a flash of light; and Group III (flash): photographed with a flash of light just before venous cannulation of a vein on the dorsum of the nondominant hand. Immediately after the photograph, venous cannulation was performed using an 18-gauge cannula. Two patients from each group could not be cannulated on their first attempt and were therefore dropped from subsequent analysis. The incidence of venous cannulation pain in the flash group was lower, i.e., 50% (14 of 28) when compared to 100% (28 of 28) observed in the other two study groups (P < 0.01). Severity of venous cannulation pain as assessed by the Visual Analog Scale scores (between 0 and 100; where 0 = no pain and 100 = worst imaginable pain) presented as median (interquartile range) were reduced in the flash [10(20)] and distraction [20(10)] groups compared with the control group [40(20)] (P < 0.01). The severity of venous cannulation pain was also reduced in the flash group compared with the distraction group (P < 0.01). We conclude that a flash of light before venous cannulation is a safe, effective, and easy-to-use method for minimizing venous cannulation pain.

Summary: We compared the incidence and severity of cough following a bolus of sufentanil with that following fentanyl in 510 patients, randomly allocated to receive sufentanil 0.3 μg.kg⁻¹, fentanyl 3 μg.kg⁻¹ or 5 ml sterile water intravenously over 5 s. Coughing was graded depending on the number of coughs as mild (1–2), moderate (3–5) and severe (> 5). The incidence of coughing was higher after sufentanil (26/165; 15%) and fentanyl (54/169; 32%) than in the control group (0/168; p < 0.001). Sufentanil was also associated with a lesser severity (p = 0.039) of coughing compared with fentanyl. We conclude that equipotent boluses of sufentanil and fentanyl increase the incidence of cough, although the incidence and severity of coughing with sufentanil are less than those with fentanyl.

To compare the efficacy and side effects of transdermal diclofenac patch with eutectic mixture of local anesthetic (EMLA) cream in attenuating venous cannulation pain. Adult ASA I or II patients undergoing elective surgery were randomly divided into three groups of 150 each. Group 1 (Control) patients received a placebo patch; Group 2 (EMLA) patients received EMLA cream; Group 3 (Diclofenac) patients received a transdermal diclofenac patch. The patches were applied at the proposed venous cannulation site 60 min prior to cannulation and pain resulting from an 18G cannula was assessed on an ten-point visual analogue scale (VAS). The cannulation site was observed for blanching, erythema, induration and edema for up to 24 hr. The incidence of venous cannulation pain was 100% in the control group, as compared to 37% and 48% of patients who experienced pain in the EMLA (P = 0.001) and diclofenac (P = 0.001) groups, respectively. The severity of venous cannulation pain [median (VAS) with interquartile ranges] was also higher in the control group: 6 (3) as compared to VAS sores of 0 (1) and 0 (2) in the EMLA (P = 0.001) and diclofenac (P = 0.001) groups. Blanching occurred with greater frequency in the EMLA group compared with the diclofenac (P = 0.001 at six hours) and placebo groups (P = 0.001 at six hours). Erythema, induration and edema were reduced in the diclofenac group compared with the EMLA (P = 0.001 for all comparisons) and placebo groups (P = 0.04 for edema at six hours andP = 0.001 for other comparisons). Transdermal diclofenac patch and EMLA are equally effective in reducing venous cannulation pain, but signs of erythema, induration and edema are less frequently observed with the transdermal diclofenac patch. Comparer l’efficacité et les effets secondaires du diclofenac transdermique au mélange eutectique d’anesthésiants locaux en crème (EMLA®) pour atténuer les douleurs associées au cathétérisme veineux. Des patients adultes ASA I et II devant subir une chirurgie élective ont été randomisés en trois groupes de 150. Un timbre placebo a été donné au groupe 1 (témoin); le groupe 2 (EMLA®) a reçu la crème EMLA®; le groupe 3 a reçu un timbre de diclofenac transdermique. Les timbres ont été appliqués au site prévu de canulation veineuse 60 min avant le cathétérisme, et la douleur provoquée par une canule de 18G a été évaluée sur une échelle visuelle analogue de onze points (EVA). L’apparition de blanchiment, d’érythème, d’induration ou d’œdème de la peau au site de canulation a été surveillée jusqu’à 24 h. L’incidence de douleur associée à la canulation veineuse fut de 100 % dans le groupe témoin, comparée à 37 % et 48 % dans les groupes EMLA® (P = 0,001) et diclofenac (P = 0,001) respectivement. La sévérité de la douleur associée à la canulation veineuse [(EVA) médian avec variations de quartile] fut également plus élevée dans le groupe témoin: 6 (3) sur l’échelle EVA comparé à 0 (1) et 0 (2) dans les groupes EMLA® (P = 0,001) et diclofenac (P = 0,001). L’apparition de blanchiment cutané fut plus fréquente dans le groupe EMLA® comparé aux groupes diclofenac (P = 0,001 à six heures) et placebo (P = 0,001 à six heures). Les érythèmes, indurations et oedèmes furent diminués dans le groupe diclofenac comparé aux groupes EMLA® (P = 0,001 pour toutes les comparaisons) et placebo (P = 0,04 pour l’œdème à six heures et P = 0,001 pour les autres comparaisons). Le diclofenac transdermique et la crème EMLA® sont tous deux efficaces pour réduire la douleur associée à la ponction veineuse, mais les signes d’érythème, d’induration et d’œdème cutané sont moins fréquents avec le diclofenac transdermique.

Summary: Insertion of a nasogastric tube is a routine procedure but during anaesthesia it is often difficult and time consuming. One hundred and sixty adults undergoing elective surgery under general anaesthesia were randomly divided into two groups. After induction of anaesthesia, neuromuscular blockade and tracheal intubation, a nasogastric tube was inserted through the nose with the head of the patient in the neutral position, either with or without prior inflation with air via a facepiece attached to a self‐inflating bag applied firmly with the face. Insertion of the nasogastric tube was successful in 75/78 (96%) following inflation compared with 54/80 (68%) without inflation (p < 0.001). In four patients receiving inflation, a fibreoptic endoscope was passed as far as the upper oesophageal sphincter; this revealed opening of the upper oesophageal sphincter during inflation.

Postoperative sore throat (POST), although a minor complication, remains a source of postoperative morbidity. We compared the efficacy of dispersible aspirin gargle to benzydamine hydrochloride (a topical nonsteroidal anti inflammatory drug) gargles for prevention of POST. We enrolled 60 consecutive female patients, 16-60 yr of age, ASA physical status I or II, undergoing elective modified radical mastectomy under general anesthesia in this prospective, randomized, placebo-controlled, single-blind study. Patients were randomly divided into 3 groups of 20 subjects each: Group 1 (C) mineral water; Group 2 (AS) tab aspirin 350 mg; and Group 3 (BH) 15 mL of benzydamine hydrochloride (0.15%). All the medications were made into 30 mL of solution. Patients were asked to gargle this mixture for 30 s, 5 min before induction of anesthesia. Grading of POST was done at 0, 2, 4, and 24 h postoperatively on a 4-point scale (0-3). Aspirin gargles reduced the incidence of POST for 4 h whereas benzydamine hydrochloride gargles reduced POST for 24 h. POST was more severe in the control group at 0 and 2 h (P < 0.05). Aspirin and benzydamine hydrochloride gargles significantly reduced the incidence and severity of POST (P < 0.05).