Intraperitoneal injection of Bupivacaine and Lidocaine in reducing postoperative pain in gynecologic laparoscopic surgeries: a comparative study

Background: As less invasive surgical procedures, such as laparoscopy, become more common, patients can go home soon after the surgery. However, some pain is accompanied by such procedures due to peritoneal stretching, diaphragmatic irritation, or, to a lesser extent, abdominal puncture. It is important to reduce the level of pain to the point that narcotics are not necessary. The administration of opioids for pain after abdominal surgeries is common. The receptors involved seem to be susceptible to blockade with low-dose local anesthesia, although this is subject to some controversy. In this study, we assess and compare the effectiveness of intraperitoneal Bupivacaine and Lidocaine in pain reduction after diagnostic gynecologic laparoscopy in infertility patients. Methods: In this randomized clinical trial, 150 patients admitted to Dr. Shariati Hospital for diagnostic gynecologic laparoscopy were entered into three randomized groups. Group B received Bupivacaine after the diagnostic laparoscopic procedure, group L received Lidocaine and group C, the control group, received a placebo after the surgery, all administered intraperi- toneally. Postsurgerical pain was assessed using the numeric visual analogue scale at 6 and 24 hours after surgery. Results: In group B, the pain scores at 6 and 24 hours after surgery were significantly less than those of group L. Conclusions: Administration of Bupivacaine after diagnostic gynecologic laparoscopic procedures is more effective in pain control than Lidocaine. The effect of this drug is temporary, yet it significantly decreases early postoperative pain, reducing the need for additional postoperative analgesics. Furthermore, the time at which patients can be discharged from the hospital is significantly reduced

COMPARISON OF PREVALENCE OF PREMENSTRUAL SYNDROME IN SWIMMER AND NON-SWIMMER STUDENTS: A HISTORICAL COHORT STUDY

"nA number of studies have examined the role of aerobic exercise and evidence suggests this may be an effective therapy for premenstrual syndrome (PMS). The aim of this study was to assess the PMS symptoms between swimmer and non-swimmer female students. Two hundred eighty subjects were studied. One hundred forty subjects were swimmers, while 140 were normal sedentary controls. Duration of swimming per week, and the length of exercise were asked from the case group. The predominant symptom of PMS was determined. PMS occurred in 36.2% and 22.8% of non-swimmers and swimmers, respectively (P = 0.00). The prevalence of premenstrual symptoms differ in the two group studied. There was no complaint about items asked in 35 (25%) and 13 (9.9%) of swimmers and non-swimmers, respectively (P = 0.000). In 11 (7.9%) swimmers, there was a problem in more than 50% of items asked, whereas 48 (17.1 %) non-swimmers had complaints in this range (P = 0.00). The prevalence of feeling more irritable, tend to eat more than usual or at irregular hours, easily distracted, restless behavior noticeable by others, feeling more angry, physical symptoms, change in mood without obvious reason, significant swelling in breasts, ankles, and abdomen, marked change in sexual desire, avoiding some social commitments, and decreasing desire to have communication with males were significantly lower in swimmers. Aerobic exercise has been found in epidemiologic studies to be associated with fewer reported premenstrual symptoms. Swimming is one of aerobic exercises which can be used in relation to this issue

Evaluating thrombophilia in severe ovarian hyperstimulation syndrome

Background: Ovarian hyper stimulation syndrome (OHSS) and its consequences, especially thromboembolic events, are of the most dangerous complications of assisted reproductive technologies (ART). It is unclear whether a thrombophilic predisposition or changes in blood components during clinical presentation of OHSS increase thrombotic risks. Testing for certain thrombophilias in selected high risk patients may help risk assessment and decision-making about prophylactic measures. Methods: In this study carried out in April 2010 to March 2011, 108 in vitro fertilization candidates with ≥20 follicles following ovarian stimulation were recruited. Protein S, protein C, antithrombin, lupus anticoagulant and anticardiolipin antibodies were measured. Blood tests were compared between severe and non-severe OHSS groups and their changes were traced after onset of clinical OHSS in 43 patients presenting with severe symptoms by repeating the tests at hospital admission. Results: Mean protein S activity was lower in severe OHSS group (101.7±16.3 vs. 118.4±17.0 P<0.001). After clinical presentation of severe OHSS, this level decreased to 91.6±20.1 (P<0.001). Antithrombin levels decreased 2.09% after the onset of symptoms in the group with severe OHSS, but this difference was not statistically significant (P=0.051). Protein C, lupus anticoagulant and anticardiolipin antibodies were not correlated to severe OHSS development. Conclusion: Patients with relatively lower protein S activity were at higher risk for the development of severe OHSS, and its dangerous consequences. During clinical OHSS presentation, protein S decreased even more, and patients were more vulnerable to hypercoagulability states. These points should be kept in mind in risk assessment and adoption of prophylactic strategies

HALF-DOSE DEPOT TRIPTORELIN COMPARABLE TO REDUCED DAILY BUSERELIN: A RANDOMIZED CLINICAL TRIAL

Pituitary suppression by depot GnRH agonist may be excessive for ovarian stimulation. This study compares the efficacy of a single half-dose depot triptorelin and reduced-dose daily buserelin in a long protocol ICSI/ET. METHODS: A total of 182 patients were randomized into two groups using sealed envelopes. Pituitary desensitization was obtained in group 1 (91 patients) with half-dose (1.87 mg) depot triptorelin in the mid-luteal phase of their menstrual cycle, and in group 2 (91 patients) with standard daily dose (0.5 mg) buserelin, which was then reduced to 0.25 mg at the start of human menopausal gonadotropin (HMG) stimulation. RESULTS: No significant differences were found among those who received HCG in terms of clinical pregnancy rate (34.4% in both groups), implantation rate (14.8% in group 1 versus 11.1% in group 2), fertilization rate (93.3 versus 95.6%), poor response rate (11.1 versus 6.7%), and miscarriage rate (11.1 versus 7.8%). No significant differences were seen in number of HMG ampoules used, follicles at HCG administration, and oocytes retrieved. The number of days of stimulation was significantly reduced in group 2 (11.2 +/- 1.8 in group 1 versus 10.6 +/- 1.9, p = 0.030). CONCLUSION: A half-dose of depot triptorelin can be successfully used in ovarian stimulation instead of reduced-dose daily buserelin, with more patient comfort and reduced stress and cost of injections

Depression and infertility: evaluation of 681 infertile women using Beck depression inventory

Introduction: Infertility and depression are major problems of today&apos;s societies. Although depression is one of the most prevalent diseases in primary care practice, consult for receiving help is carried out much less than true prevalence of the disease. Therefore gathering information about prevalence and risk factors of depression is very valuable. Beck Depression Inventory (BDI) which is a screening tool for depression can be used in Iranian patients because of availability of a validated translation. The objective of this study was to estimate the prevalence of depression in infertile subjects in an infertility center. Materials and Methods: In this study, 681 infertile women were evaluated in Shariati Hospital, Tehran. Demographic information’s including age, duration, type and cause of infertility, level of education, previous treatments and smoking habits were recorded. BDI was completed by patients and score was estimated. Score of 16 and higher was assumed positive. Results: There was no relationship between age and prevalence of positive BDI score, but prevalence of positive BDI score was higher in infertilities of longer duration, infertilities caused by both male and female factors and in patients with low level of education and history of previous treatment or surgical therapy. Conclusion: Infertile patients are at risk of depression. Rate of consulting with psychiatrists and getting help is low in our country due to cultural aspects, so screening of high risk subgroups in infertile patients and referring them to psychiatrist would be very helpful

Methotrexate or expectant management in women with an ectopic pregnancy or pregnancy of unknown location and low serum hCG concentrations? A randomized comparison

What is the treatment success rate of systemic methotrexate (MTX) compared with expectant management in women with an ectopic pregnancy or a pregnancy of unknown location (PUL) with low and plateauing serum hCG concentrations? SUMMARY ANSWER: In women with an ectopic pregnancy or a PUL and low and plateauing serum hCG concentrations, expectant management is an alternative to medical treatment with single-dose systemic MTX. WHAT IS KNOWN AND WHAT THIS PAPER ADDS: MTX is often used in asymptomatic women with an ectopic pregnancy or a PUL with low and plateauing serum hCG concentrations. These pregnancies may be self-limiting and watchful waiting is suggested as an alternative, but evidence from RCTs is lacking. The results of this RCT show that expectant management is an alternative to treatment with systemic MTX in a single-dose regimen in these women. STUDY DESIGN, SIZE, DURATION: A multicentre RCT women were assigned to systemic MTX (single dose) treatment or expectant management, using a web-based randomization program, block randomization with stratification for hospital and serum hCG concentration ( 18 years old with both an ectopic pregnancy visible on transvaginal sonography and a plateauing serum hCG concentration <1500 IU/l or with a PUL and a plateauing serum hCG concentration <2000 IU/l were eligible for the trial. We included 73 women of whom 41 were allocated to single-dose MTX and 32 to expectant management. There was no difference in primary treatment success rate of single-dose MTX versus expectant management, 31/41 (76%) and 19/32 (59%), respectively [relative risk (RR) 1.3 95% confidence interval (CI) 0.9-1.8]. In nine women (22%), additional MTX injections were needed, compared with nine women (28%) in whom systemic MTX was administered after initial expectant management (RR 0.8; 95% CI 0.4-1.7). One woman (2%) from the MTX group underwent surgery compared with four women (13%) in the expectant management group (RR 0.2; 95% CI 0.02-1.7), all after experiencing abdominal pain within the first week of follow-up. In the MTX group, nine women reported side effects versus none in the expectant management group. No serious adverse events were reported. Single-dose systemic MTX does not have a larger treatment effect compared with expectant management in women with an ectopic pregnancy or a PUL and low and plateauing serum hCG concentrations. WIDER IMPLICATIONS OF THE FINDINGS: Sixty percent of women after expectant management had an uneventful clinical course with steadily declining serum hCG levels without any intervention, which means that MTX, a potentially harmful drug, can be withheld in these women. BIAS, LIMITATION AND GENERALISABILITY: A limitation of this RCT is that it was an open (not placebo controlled) trial. Nevertheless, introduction of bias was probably limited by the strict criteria to be fulfilled for treatment with MTX. STUDY FUNDING: This trial is supported by a grant of the Netherlands Organization for Health Research and Development (ZonMw Clinical fellow grant 90700154). ISRCTN 4821049