Comparison Of Post Operative Pain After Port Closure Using Spinal Needle And Port Closure Needle In Patients Undergoing Laparoscopic Appendectomy – A Hospital Based Randomised Controlled Trial

Abstract

Background and Objectives Acute appendicitis is the most common cause of acute abdominal pain that requires surgical intervention. While history taking and clinical examination continue to be a cornerstone for the diagnosis of the disease, modern imaging techniques and minimally invasive surgery, has brought about a vast difference in the management of acute appendicitis, with appendectomy still being the gold standard treatment. Since the advent of minimally invasive surgery, laparoscopic appendectomy has become the procedure of choice. Despite the advantages associated with laparoscopy, considerable postoperative pain still remains a major cause of concern to the patients. There have been numerous methods that have been investigated to minimalize the post-operative pain, the technique of port closure being one of it. The objective of this was to study compare the incidence of postoperative pain after port closure using commonly available spinal needle and port closure needle following laparoscopic appendectomy. Materials and Methods The present study was conducted on patients admitted with the diagnosis of appendicitis in the Department of General Surgery of KLES Dr. Prabhakar Kore Hospital and Medical Research Centre from January 2018 to December 2018. Relevant data was collected by a detailed interview with the patient, clinical examination and blood investigations. The patients were then divided into two groups - Group A and Group B pre-operatively for port closure with Group A undergoing closure with an 18-gauge Spinal Needle Technique and Group B undergoing closure with Port closure needle technique. Pain was then assessed using Visual Analogue Scale at 6 hours, 12 hours and 18 hours post-surgery. Statistical analysis was done using Independent t-test, Mann-Whitney U test and Wilcoxon matched pairs test. Results Of the 60 patients enrolled in the study, the mean age in group A was 29.50 years and that in Group B was 30.70 years with equal number of males and females in each group. There was found to be no significant difference in pain by VAS in the two groups at 6 hours and 12 hours, but at 18 hours post-operative, the pain was significantly less in the patients of Group A who underwent closure with 18-gauge Spinal Needle technique (p value 0.0321). The pain reduction between 6-12 hours and 6-18 hours was statistically more in Group A (p value 0.0211 and 0.0184 respectively). Conclusion Laparoscopic surgeries do cause pain post-operatively and addressing it is a major factor in determining the patient’s recovery post the surgery. There have been numerous techniques that have been described for port closure, standard not being defined yet. The technique chosen should minimise the tissue damage at the same time achieve adequate fascial closure. The spinal needle technique was found to be more effective in reducing the incidence of pain in the immediate post-operative period.