Preemptive use of adjunctive IV lidocaine for enhanced recovery after abdominal hysterectomy for overweight and obese women: a prospective, randomized, double-blind, placebo-controlled study

Background: This investigation planned to evaluate the clinical results of adjunctive IV lidocaine bolus dose plus infusion for one hour after surgery in patients who underwent an abdominal hysterectomy in obese and overweight women.Methods: We performed a double-blind, placebo-controlled study, (ClinicalTrials.gov identifier: NC03748108), with patients undergoing abdominal hysterectomy divided into 2 groups: one group received intravenous lidocaine single bolus dose preoperatively and IV infusions till one hour after the surgical procedure, and the opposite received normal saline infusion (placebo). We assessed postoperative results, including pain scores rankings on a visual analog scale (VAS) in rest and movement, administration frequency of pethidine. Postoperative nausea and vomiting, the period of hospital stay (LOS), time to ambulate, and patient satisfaction at forty-eight hours had been evaluated. Chi-square test and Monte Carlo test have been used for comparison among groups.Results: There were 120 patients in our study. The visual analog scale (VAS), pain scores, length of hospital stay (LOS), and administration frequency of pethidine were significantly lower in the lidocaine group. The total amount of consumed pethidine was significantly lower in the lidocaine than the placebo group. There was a significant reduction in post-operative pain which was assessed by visual analog scale (VAS) after 2,4,8,12, and 24 hours either during movement or during rest in the lidocaine group compared to the placebo group, p=(0. 0001,0.0001,0.0001,0.0001 and 0.0001).Conclusions: The administration of adjuvant intravenous lidocaine infusion reduces pain during the postoperative period after abdominal hysterectomy, is associated with early recovery, decreased postoperative opioid analgesic requirement, and better patient satisfaction in overweight and obese women undergoing abdominal hysterectomy.

The Role of Diagnostic Laparoscopy in the Unexplained Infertility Cases

Purpose: The study examines how useful laparoscopy is in finalizing the diagnosis of unexplained infertility. Materials: The study included 50 women with 1 year or 2 years of infertility,  who had a regular marital life with unprotected intercourse for more than a year, normal husband's semen analysis, normal ovulation by folliculometry, normal hormonal profile, and normal hysterosalpingogram at the department of Obstetrics and Gynecology at Aswan University Hospital from January to December 2019. Methods: This is a cross-sectional observational study involving 50 women who underwent diagnostic laparoscopy after investigations and imaging failed to reveal the cause of infertility. During the procedure, the pelvis was inspected for any pathology, including the uterus, fallopian tubes, round ligaments, ureterovesical pouch, uterosacral ligaments, Douglas pouch, and ovarian fossae. Results: Diagnostic laparoscopy helped uncover abnormal pathologies such as endometriosis, adhesions, and tubal pathologies in 30 women (60%) of the 50 included in the study, whereas no abnormality was detected in the remaining 20 (40%). Conclusion: Laparoscopy is not only a crucial diagnostic technique in infertility patients, but it can also help with treatment selections. Conducting laparoscopy in cases of unexplained infertility is linked to both peritubular adhesions and pelvic endometriosis. These pelvic disorders might not be appropriately detected or treated without laparoscopy, and hysterosalpingography and basic imaging such as pelvic ultrasonography are frequently ignored