BACKGROUND: Laparoscopic cholecystectomy, although is less invasive than open surgery, is not completely pain free. The use of local anaesthesia to relieve pain following this procedure is a common practice. However, it remains debatable whether a pre- or post-operative drug administration is more effective. Here, we investigated the role of preemptive local anaesthetic infiltration given pre- or post-incisional, in relieving the pain during laparoscopic surgery. METHODOLOGY: A randomized controlled trial was conducted with 96 patients receiving 0.5% Bupivacaine 100mg. Group A (n=48) received post-incisional skin infiltration whilst Group B (n=48) received pre-incisional infiltration. Incisional (somatic) and intra-abdominal (visceral) pain was assessed using Visual Analog Scale (VAS) at day 0, day 1 and day 7 post-operative days. RESULT: Baseline characteristics between the two groups were similar. Incisional pain was lower in Group B as compared to Group A at day 0 (P=0.03) and day 1 (P<0.01). Intra-abdominal pain was also lower in Group B at day 0 and day 1 (P= 0.04). VAS score was similar at day 7 although analgesia requirement is higher in Group A (P>0.05). CONCLUSION: Administration of pre-incisional local anaesthesia offers better pre-emptive pain relief measure than postincisional administration by reducing somatic and visceral pain in laparoscopic gall bladder surgery.
Cholecystectomy, Laparoscopic

The aim of this study was to validate the translation of the Overactive Bladder (OAB) Screener (OAB V8) to the Malay language. It was to assess the reliability of the screener in the context of a Malaysian population. The original screener consists of eight symptoms indicative of OAB that has been proven to be highly sensitive and reliable. Translation was done with a modification of the Brislin Method using back translation and a panel of experts as a final review panel. The pilot study had two groups; a symptomatic (n=19 patients) and an asymptomatic group (n=18 patients). All patients performed the test twice at two week intervals once at the clinic and subsequently at home. Test-retest method was used for reliability and Cronbach’s alpha for internal consistency. The translated questionnaire demonstrated good internal consistency in both groups of patients for all eight items individually and for the total score. Cronbach’s alphas ranged from 0.972 to 0.981 for the symptomatic group and from 0.750 to 0.976 for the asymptomatic group. Testretest correlation for all items was highly significant. Intraclass correlation (ICC) was high for both the asymptomatic (ICC ranging from 0.600 to 0.953) and the symptomatic group (ranging from 0.944 to 0.989).The Malay OAB V8 showed itself to be suitable for use, reliable in distinguishing symptomatic and asymptomatic patients and a valid instrument.

Diabetes mellitus has reached epidemic levels in Malaysia due to increase in its risk factors such as obesity, dietary and sedentary lifestyle. In patients with uncontrolled diabetes mellitus, diabetic foot ulcer (DFU)is a common complication. Managing diabetic foot infection is often multifactorial and intricate. The management DFU demands multi-speciality approach and often tedious. Hyperbaric oxygen therapy (HBOT) is a promising adjunctive treatment used to enhance the healing process plus reduces cost and recovery time. This is a case of a 52 years old lady, with underlying poorly diabetes mellitus, who presented with diabetic foot ulcer Wagner IV classification in sepsis. She underwent trans-metatarsal amputation followed by split skin grafting with additional adjunctive HBOT in a tertiary hospital.

Introduction: Dexmedetomidine, a selective α2 -adrenoreceptor agonist is an important adjuvant to general anaesthetic practice in view of its potent sedative, anaesthetic-sparing and analgesic effects. We investigated the effect of a single dose pre – induction dexmedetomidine on the anaesthetic requirement during surgery and pain profile. Methods: 60 patients who were ASA I - II and planned for orthopaedic procedures under general anaesthesia were recruited. Patients were randomized into 2 groups: Group D received intravenous (IV) dexmedetomidine 1 µg/ kg (n=30) preoperatively or Group P received normal saline (n=30) instead. Both groups were induced with standardised IV induction agents and anaesthesia maintained with Sevoflurane, titrated using the bispectral index scale. The expired fraction of sevoflurane and haemodynamic parameters were recorded at 5-minute intervals intraoperatively. Postoperatively, postoperative pain score (VAS) was documented at 30 minutes recovery. Results: Our study showed a 27.8% reduction in the intraoperative expired fraction of sevoflurane requirement in group D versus 11.5% reduction in Group P (p < 0.001) and a lower mean heart rate in Group D as compared to Group P [mean (CI): 69.20 (64.03, 74.37) versus 82.00 (72.12, 91.87) per minute, p = 0.00]. The mean (SD) VAS for 30 minutes postoperative pain was significantly lower in group D when compared to group P [1.507(0.275) vs 2.209(0.403), p = 0.00]. Conclusion: This study has shown that a single dose of pre-induction dexmedetomidine was able to significantly reduce anaesthetic requirement of sevoflurane and mean heart rate intraoperatively and postoperative pain.