Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Local infiltration versus laparoscopic-guided transverse abdominis plane block in laparoscopic cholecystectomy: double-blinded randomized control trial(Springer, 2019) Siriwardana, R.C.; Kumarage, S.K.; Gunetilleke, M.B.; Thilakarathne, S.B.; Wijesinghe, J.S.BACKGROUND: Transverse abdominal plane block (TAP) is a new technique of regional block described to reduce postoperative pain in laparoscopic cholecystectomy (LC). Recent reports describe an easy technique to deliver local anesthetic agent under laparoscopic guidance. METHODS: This randomized control trial was designed to compare the effectiveness of additional laparoscopic-guided TAP block against the standard full thickness port site infiltration. 45 patients were randomized in to each arm after excluding emergency LC, conversions, ones with coagulopathy, pregnancy and allergy to local anesthetics. All cases were four ports LC. Interventions-Both groups received standard port site infiltration with 3-5 ml of 0.25% bupivacaine. The test group received additional laparoscopic-guided TAP block with 20 ml of 0.25% bupivacaine subcostally, between the anterior axillary and mid clavicular lines. As outcome measures the pain score, opioid requirement, episodes of nausea and vomiting and time to mobilize was measured at 6 hourly intervals. RESULTS: The two groups were comparable in the age, gender, body mass index, indication for cholecystectomy difficulty index and surgery duration. The pain score at 6 h (P = 0.043) and opioid requirement at 6 h (P = 0.026) was higher in the TAP group. These were similar in subsequent assessments. Other secondary outcomes were similar in the two groups. CONCLUSION: Laparoscopic-guided transverses abdominis plane block using plain bupivacaine does not give an additional pain relief or other favorable outcomes. It can worsen the pain scores.Item Water extracts of leaves and stems of pre-flowering but not flowering plants possess analgesic and antihyperalgesic activities in rat(Informa Healthcare, 2003) Dharmasiri, M.G.; Ratnasooriya, W.D.; Thabrew, M.I.According to Sri Lankan traditional medicine, a decoction made from stems and leaves of Anisomeles indica Kuntze (Lamiaceae) possesses analgesic activity. However, the validity of this claim has not been scientifically tested. The aim of this study was to investigate analgesic and antihyperalgesic activities of this plant using a water extract made from the leaves and stems. The water extracts were made from leaves and stems of both preflowering (E1) and flowering plants (E2). E1 showed a dose-dependent analgesic effect up to 6 h of treatment when tested in rats using the hot plate and the tail flick techniques. Further, the analgesic effect of E1 was not accompanied by toxic effects. This effect was neither gender dependent nor dependent on the stage of the estrous cycle. E1 also showed a dose-dependent antihyperalgesic activity in the hot plate test. In contrast, E2 did not show any analgesic effect (500 mg/kg). The analgesic effect produced by E1 was not abolished by naloxone. E1 dose-dependently retarded the amplitude of the spontaneous contractions of isolated dioestrous rat uterus. Further, E1 induced a dosedependent plasma membrane stabilisation effect on rat erythrocytes. Collectively, these observations suggest that the analgesic and antihyperalgesic effects of E1 are mediated from inhibition of COX-1, thus impairing the synthesis of prostaglandins. A change in chemical contents that accompanies flowering could be one possible reason for the inability of E2 to demonstrate analgesic effect.