RESUMEN
Background: Isoflurane and propofol are routinely used for the maintenance of general anaesthesia. However, recently, they have been implicated in hepatotoxicity resulting in acute liver failure. Objective: We compared the effects of isoflurane and propofol on liver enzymes; aspartate transaminases (AST), alanine transaminases (ALT), alkaline phosphatase (ALP) and total bilirubin (Tbil) following general anaesthesia. Materials and Methods: This randomized, controlled clinical trial involved 60 ASA I and II patients aged 18-64 years scheduled for elective surgery requiring general anaesthesia. Anaesthesia was induced with intravenous sodium thiopentone 5 mg/kg and atracurium 0.5 mg/kg, and maintained in group I with isoflurane (MAC, 0.8%-1.5%) and in group P with (propofol infusion, 100-200µg/kg/minute). Blood samples were taken pre-induction, immediate- and 24 hours post operatively. The serum levels of AST, ALT, ALP, Tbil were analyzed and compared in both groups. Risk factors for post operative hepatotoxicity were determined. Result: Propofol caused a significant reduction in ALP (P = 0.005) but increase in Tbil (P = 0.010) 24 hours postoperatively. Though isoflurane had consistently higher values of AST, ALP and Tbil than propofol, only the mean AST values at 24 hours post-operative was significantly higher (P = 0.045). There was a significant increase in the 24 hours post-operative Tbil following massive blood loss; [odd ratio 23.91, 95%, CI (1.685-339.315)], P = 0.019. Conclusion: Both agents had a varied effect on liver enzymes. Isoflurane resulted in a significantly higher increase in 24 hours post-operative serum AST than propofol. Propofol caused a significant increase in 24 hours post-operative total bilirubin. Caution is therefore recommended in their use in patients with altered liver enzymes.
RESUMEN
BACKGROUND: The Ilioinguinal/iliohypogastric nerve block has been shown to significantly decrease opioid analgesic requirements and side effects after inguinal herniotomy. We compared the effect of pre-incisional field block with 0.25% bupivacaine and post-incisional wound infiltration with 0.25% bupivacaine for postoperative pain control after inguinal herniotomy. PATIENTS & METHODS: This was a randomized controlled double blind study in 62 ASA I and II children aged 1-7 years scheduled for inguinal herniotomy. They were assigned to receive either pre-incision field block (group I) or post-incision wound infiltration at the time of wound closure (group II). The pain score was assessed in the recovery room using mCHEOPS score and VAS or FLACC score at home by the parents for 24 hours. RESULTS: The mean pain scores during the 2 hour stay in the recovery room, at 12 and 18 hours at home were similar in both groups, p > 0.05. However, the mean pain scores were significantly lower at 6 hours at home in group I (1.22 ± 0.57) than in group II (1.58 ±0.90), p <0.001, but significantly higher at 24 hours at home in group I (3.29 ± 0.46) than in group II (2.32 ± 0.24), p = 0.040. There was no difference in mean paracetamol requirement, and in the number of patients who required paracetamol for pain relief at home in both groups, p > 0.05. CONCLUSION: We have demonstrated that both pre-incisional ilioinguinal/iliohypogastric field block and post incisional wound infiltration provided adequate postoperative analgesia for 24 hours after inguinal herniotomy.