Low Dose Perioperative Lidocaine Infusion for Post-Operative Pain in Open Cholecystectomy

compare low dose peri-operative lidocaine infusion and placebo for post-operative mean pain score and mean analgesic requirement in open cholecystectomy.Methods: In this prospective randomized comparative study 120 patients, undergoing open cholecystectomy in general anaesthesia, were included. Patients were randomly allocated to either lidocaine infusion (L) or saline group (S) using systematic randomized sampling with 60 patients in each group. Patients in the lidocaine infusion group were given bolus injection of lidocaine 30 minutes before the skin incision followed by a continuous intraveonous via infusion pump whereas the patients in the saline group received 0.9% normal saline in equal volume and in the same manner. The infusion was continued throughout the surgery and was terminated 60 min after the skin closure.Results: Out of the 120 patients 34 (28.3%) were male while 86 (71.7%) were female. Mean age was 41.32±11.512 years. Both mean VAS pain score and mean analgesic requirement were found to be significantly lower in the lidocaine Group (p-values 0.04 and 0.29 respectively), as compared to controls.Conclusion: Peri-operative low dose systemic lidocaine appears to reduce pain in the immediate post-operative period

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.The aim of this study was to inform vaccination prioritization by modelling the impact of vaccination on elective inpatient surgery. The study found that patients aged at least 70 years needing elective surgery should be prioritized alongside other high-risk groups during early vaccination programmes. Once vaccines are rolled out to younger populations, prioritizing surgical patients is advantageous