The British journal of surgery
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Randomized Controlled Trial Clinical Trial
Randomized trial of periportal peritoneal bupivacaine for pain relief after laparoscopic cholecystectomy.
The aim of this study was to determine whether injection of a long-acting local anaesthetic, in relation to the port sites at the level of the parietal peritoneum, would reduce postoperative pain following laparoscopic cholecystectomy. Patients were entered into a randomized, prospective, double-blind study comparing the effects of a standard technique, in which bupivacaine (total of 20 ml, 0.5 per cent) was injected into the subcutaneous periportal tissue around the four port sites, and a technique in which bupivacaine (total of 20 ml, 0.25 per cent) was injected into the subcutaneous periportal tissue as above with the addition of periportal parietal peritoneal injection of bupivacaine (total of 20 ml, 0.25 per cent). ⋯ Both opiate and oral analgesic requirements were reduced in patients administered peritoneal injection, although this was not statistically significant. The addition of periportal injection of bupivacaine at the level of the parietal peritoneum, performed under direct vision, reduces pain after laparoscopic cholecystectomy.
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Cancer of the oesophagus has great diversity in geographical distribution and incidence. The rate of oesophageal cancer has been increasing in some areas and the reasons for this are not clear. ⋯ Chronic irritation of the oesophagus appears to participate in the process of carcinogenesis, particularly in patients with thermal and/or mechanical injury, achalasia, oesophageal diverticulum, chronic lye stricture, radiation therapy, injection sclerotherapy and gastric resection before the appearance of oesophageal tumour. The association of Plummer-Vinson syndrome, coeliac disease, tylosis and scleroderma with oesophageal cancer has also been reviewed.