Acetazolamide Reduces Referred Postoperative Pain after Laparoscopic Surgery with Carbon Dioxide Insufflation

Background: Carbon dioxide is the preferred insufflating gas for laparoscopy because of greater safety in the event of intravenous embolism, but it causes abdominal and referred pain. Acidification of the peritoneum by carbonic acid may be the major cause of pain from carbon dioxide insufflation. Carbonic anhydrase is an enzyme that increases the rate of carbonic acid formation from carbon dioxide. Because acetazolamide inhibits carbonic anhydrase, the authors hypothesized that the pain caused by carbon dioxide insufflation may be decreased by the administration of acetazolamide.

Methods: A prospective, randomized, double-blind study of 38 patients undergoing laparoscopic surgery during general anesthesia was performed. Acetazolamide (5 mg/kg) or a saline placebo was administered intravenously during surgery. Pain was rated on a visual analog scale (0-10) at four times: when first awake, at discharge from the recovery room, when discharged from the hospital, and on the day after surgery. The site and quality of pain were recorded, as were medications and side effects.

Results: Initial referred pain scores were lower after acetazolamide (1.00 +/- 1.98; n = 18) than after placebo (3.40 +/- 3.48; n = 20; P = 0.014), and 78% of patients in the acetazolamide group had no referred pain; however, only 45% patients in the placebo group had no referred pain. Incisional pain scores were not statistically different, and referred pain scores were similar at later times.     

Acetazolamide reduces referred postoperative pain after laparoscopic surgery with carbon dioxide insufflation

BACKGROUND: Carbon dioxide is the preferred insufflating gas for laparoscopy because of greater safety in the event of intravenous embolism, but it causes abdominal and referred pain. Acidification of the peritoneum by carbonic acid may be the major cause of pain from carbon dioxide insufflation. Carbonic anhydrase is an enzyme that increases the rate of carbonic acid formation from carbon dioxide. Because acetazolamide inhibits carbonic anhydrase, the authors hypothesized that the pain caused by carbon dioxide insufflation may be decreased by the administration of acetazolamide. METHODS: A prospective, randomized, double-blind study of 38 patients undergoing laparoscopic surgery during general anesthesia was performed. Acetazolamide (5 mg/kg) or a saline placebo was administered intravenously during surgery. Pain was rated on a visual analog scale (0-10) at four times: when first awake, at discharge from the recovery room, when discharged from the hospital, and on the day after surgery. The site and quality of pain were recorded, as were medications and side effects. RESULTS: Initial referred pain scores were lower after acetazolamide (1.00 +/- 1.98; n = 18) than after placebo (3.40 +/- 3.48; n = 20; P = 0.014), and 78% of patients in the acetazolamide group had no referred pain; however, only 45% patients in the placebo group had no referred pain. Incisional pain scores were not statistically different, and referred pain scores were similar at later times. CONCLUSIONS: Acetazolamide reduces referred but not incisional pain after laparoscopic surgical procedures. The duration of pain reduction is limited to the immediate postsurgical period.     

Hypertension intracrânienne bénigne : place du traitement médical

The goal of medical treatment in benign intracranial hypertension (BIH) is to treat intracranial hypertension symptoms as well as to preserve vision. Reducing the production rate of cerebrospinal fluid can be achieved using acetazolamide and/or furosemide (carbonic anhydrase inhibitors), although acetazolamide is the most effective drug. The use of steroids is debatable in BIH. This review focuses on the pathophysiology of these medications, followed by the report of a series of 16 pediatric patients suffering from BIH (1996-2006). BIH was idiopathic for eight children. Depletive lumbar punctures were effective, but this result was often transient. All children were treated with acetazolamide. Doses of acetazolamide (10-20 mg/kg per day) must be given every 8 h to respect its kinetics. This treatment has to be continued for at least several months and decreasing the dosage must be progressive. Hypokalemia is always prevented with oral potassium. There was only one true treatment failure requiring surgery. The authors therefore advise acetazolamide as a first-line treatment (combined with etiologic treatment, if available, in cases of nonidiopathic situations) in BIH.     

Acetazolamide-induced renal calculi.

The occurrence of urinary calculi associated with acetazolamide therapy is described. Patients with a history of urinary stones or surgery are a significant risk for further calculus formation when treated with acetazolamide. The concurrent use of sodium bicarbonate further potentiates this risk.     

Idiopathic Intracranial Hypertension

Idiopathic intracranial hypertension (IIH) is a disorder of raised intracranial pressure of unknown etiology. For overweight or obese patients with IIH, weight reduction of 5% to 10% of total body weight at diagnosis is a long-term treatment strategy. Though not proven, the initiation of acetazolamide can assist in symptom reduction and resolution. In patients with either fulminant IIH or those on maximal medical management with progressive vision loss, intravenous steroids and acetazolamide can be initiated while surgical options are urgently arranged. Because of its lower complication rate, I prefer to use optic nerve sheath fenestration in settings of precipitous visual decline, but I have used cerebrospinal fluid diversion surgery in settings of vision loss with severe, intractable headache. Often, the choice of surgical intervention is individualized for the patient and the available expertise. In the future, results from the ongoing multicenter, double-blind, placebo-controlled Idiopathic Intracranial Hypertension Treatment Trial (IIHTT) will provide important data regarding the efficacy of acetazolamide and the utility of diet and exercise.     

Metabolic changes after H(2) 15O-positron emission tomography with acetazolamide in a patient with moyamoya disease: case report and review of previous cases

Perioperative ischemic complications not directly related to surgery require special attention in patients with moyamoya disease; positron emission tomography (H(2) 15O-PET) and single-photon emission computed tomography have been considered indispensable for evaluating pre- and postsurgical cerebral hemodynamics. The clinical records of 14 patients with moyamoya disease who underwent 26 extracranial-intracranial bypass operations were reviewed with special reference to perisurgical complications. One patient developed multiple postoperative ischemic infarctions and died of ischemic brain edema. The history of this patient with prolonged acidosis is analyzed, and the role of metabolic changes induced by H(2) 15O-PET with acetazolamide challenge is reviewed. Seven (77.8%) of nine patients operated on within 48 hours after H(2) 15O-PET with acetazolamide (group 1) developed metabolic acidosis, whereas only three (17.6%) of 17 patients operated on >48 hours (group 2) after the examination had intraoperative pH of <7.35. In group 1, the mean intraoperative pH was 7.328, which was significantly lower than the mean pH of 7.393 (P <.0001) in group 2. After H(2) 15O-PET with acetazolamide challenge, patients must be carefully observed concerning acidosis and volume state. We recommend at least 48 hours between examination and surgery for patients with moyamoya disease so that their conditions can stabilize. Furthermore, special care should be taken to avoid additional perioperative risk factors such as hypotension, hypocapnia, hypercapnia, and hypovolemia.     

A case of adult moyamoya disease progressed after vascular reconstructive surgery

We report an adult onset patient with moyamoya disease showing acute progress after contralateral vascular reconstructive surgery. A 47-year-old female developed cerebral infarction in the left corona radiata. A magnetic resonance (MR) angiography and a cerebral angiogram revealed severe stenosis extending from the terminal portion of left internal carotid artery (ICA) to the M1 portion. The right ICA showed slight stenosis. We performed direct bypass surgery (STA-MCA anastomosis) on the affected left side. MR angiography 1 month after surgery revealed the progressive stenosis of the C1 portion of the right ICA. While measurement of cerebral blood flow (CBF) showed a slight impairment of vascular reactivity to acetazolamide loading in the region of the right MCA, we continued without vascular reconstructive surgery for the right side because there was no ischemic attack. The patient had a transient sensory disturbance of the left upper extremity 16 months after surgery. MR angiography and a cerebral angiogram revealed more progressive stenosis extending from the right ICA to the M1 portion. CBF study showed a low CBF at rest and a negative response to acetazolamide loading in the region of the right MCA. Direct bypass surgery was performed on the right hemisphere. Follow-up study revealed an increment of rest CBF and improvement of vascular reactivity. We underlined the necessity for careful postoperation observation of progressive contralateral arterial stenosis using MR angiography and CBF study in adult onset patients with moyamoya disease.     

CO2 elimination in ophthalmic surgery after administration of acetazolamide

The authors studied the influence on CO2 elimination in lungs of acetazolamide given before ophthalmic surgery. The changes in PaCO2, PETCO2, (a-ET) PCO2, ventilation volume (VE), and respiratory rate (RR) were measured before and 6 hours after administration of acetazolamide (500mg, p. o.). Comparison of PETCO2, PaCO2, (a-ET) PCO2, VE and RR after the operation with or without treatment with acetazolamide showed that (a-ET) PCO2 increased significantly and the increase of PaCO2 in post-anesthesia period was less with the treatment of acetazolamide. In other words, ventilation was stimulated by acetazolamide as the decrease in VE was less in post-anesthesia period. It may be concluded that oral administration of acetazolamide 500mg does not interfere with CO2 elimination.     

Adverse effects of intravenous acetazolamide administration for evaluation of cerebrovascular reactivity using brain perfusion single-photon emission computed tomography in patients with major cerebral artery steno-occlusive diseases

Adverse effects of intravenous acetazolamide administration for evaluation of cerebrovascular reactivity using brain perfusion single-photon emission computed tomography (SPECT) were prospectively investigated in 100 patients with major cerebral artery, atherosclerotic, and steno-occlusive diseases. All patients underwent two SPECT studies (with and without acetazolamide challenge) at an interval of 2 or 3 days, received a questionnaire immediately after each SPECT study, and returned the answered questionnaire within 7 days after the study. None of the 100 patients studied experienced any symptoms during the SPECT study without acetazolamide challenge. Sixty-three patients (63%) developed symptoms during the SPECT study with acetazolamide challenge, such as headache, nausea, dizziness, tinnitus, numbness of the extremities, motor weakness of the extremities, and general malaise 1-3 hours (mean 1.6 hours) after administration of acetazolamide, and these symptoms lasted for 0.5-72 hours (mean 7.9 hours). Multivariate statistical analysis revealed that younger age (95% confidence interval [CI] 0.896-0.980, p = 0.0047) and female sex (95% CI 1.178-16.129, p = 0.0274) were significantly associated with development of symptoms with acetazolamide challenge. The incidences of the development of symptoms with acetazolamide challenge were 91% (21/23) and 41% (12/29) in subgroups of women <70 years and men ≥70 years, respectively. Patients should be informed of such adverse effects of intravenous acetazolamide administration prior to the acetazolamide challenge test for evaluation of cerebrovascular reactivity.     

Prolonged aqueous humor levels of subconjunctival antibiotics after treatment with acetazolamide and/or timolol

Many ophthalmologists routinely administer subconjunctival antibiotics at the end of cataract surgery for prophylaxis against bacterial endophthalmitis. Additionally they use acetazolamide and/or timolol to control intraocular pressure in the first 24-hour postoperative period. An animal study was undertaken to learn whether treatment with the aqueous humor suppressants, acetazolamide, and timolol prolongs the concentrations of antibiotics in the aqueous humor after subconjunctival administration of the antibiotic. Treatment with acetazolamide significantly increased concentrations of piperacillin; it had less consistent effects on tobramycin levels. Timolol treatment did not produce increased piperacillin concentrations at six hours; however, concentrations at 12 and 24 hours were significantly higher than in the controls. Timolol treatment increased tobramycin concentrations only at six hours. The combined use of timolol and acetazolamide produced significantly higher concentrations of piperacillin, but not of tobramycin.     

Shaking limb transient ischemic attacks: unusual presentation of carotid artery occlusive disease: report of two cases

OBJECTIVE AND IMPORTANCE: Shaking limb transient ischemic attacks (TIAs) represent a rare clinical syndrome that has been ascribed to focal cerebral ischemia attributable to insufficient brain perfusion, usually resulting from carotid artery occlusive disease. The techniques conventionally used to evaluate this condition are contrast angiography, carotid artery ultrasonography, and magnetic resonance angiography. Treatment consists of internal carotid artery (ICA) endarterectomy or, in the case of complete ICA occlusion, extracranial-intracranial bypass. In this report, two patients with shaking limb TIAs are presented. For one patient, preoperative evaluations included single-photon emission computed tomographic studies with acetazolamide vasodilator challenge; for the second patient, computed tomographic angiography was used to assess vascular anatomic features. CLINICAL PRESENTATION: Two patients with severe carotid artery disease presented with brief, recurrent, shaking limb TIAs. Angiograms obtained for Patient 1 demonstrated complete ICA occlusion in association with severe external carotid artery stenosis, whereas preoperative single-photon emission computed tomographic scans revealed a lack of cerebrovascular reserve in response to acetazolamide challenge. Carotid artery duplex ultrasonography and computed tomographic angiography demonstrated severe stenosis of the ICA for Patient 2. INTERVENTION: Patient 1 underwent a left external carotid artery endarterectomy. Patient 2 underwent a right ICA endarterectomy. CONCLUSION: After surgery, the shaking limb episodes ceased for both patients. Postoperative single-photon emission computed tomographic scans for Patient 1 demonstrated increased cerebral blood flow in response to acetazolamide challenge. These data provide support for the concept that shaking limb TIAs are related to hemodynamic failure and that improvements in cerebral blood flow through conducting vessels can alleviate the condition.     

Pressure autoregulation and positron emission tomography-derived cerebral blood flow acetazolamide reactivity in patients with carotid artery stenosis

OBJECTIVE: Testing autoregulation is of importance in predicting risk of stroke and managing patients with occlusive carotid arterial disease. The use of small spontaneous changes in arterial blood pressure and transcranial Doppler (TCD) flow velocity can be used to assess autoregulation noninvasively without the need for a cerebrovascular challenge. We have previously described an index (called "Mx") that achieves this. Negative or low positive values (<0.4) indicate intact pressure autoregulation, whereas an Mx greater than 0.4 indicates diminished autoregulation. The objective of this study was to compare acetazolamide reactivity of positron emission tomography (PET)-derived cerebral blood flow (CBF) with Mx in patients with carotid arterial disease. METHODS: In 40 patients with carotid arterial disease, we used bilateral TCD recordings of the middle cerebral artery to derive Mx and compared this with PET-derived CBF measurements of acetazolamide reactivity. RESULTS: Mx correlated inversely with baseline PET CBF (P = 0.042, R = -0.349) but not with postacetazolamide CBF or cerebrovascular reactivity to acetazolamide. This may reflect discordance between pressure autoregulation and acetazolamide reactivity. Mx correlated significantly with degree of internal carotid artery stenosis (P = 0.022, R = 0.38), whereas CBF reactivity to acetazolamide did not correlate with Mx (P = 0.22). After the administration of acetazolamide, slow-wave activity in blood pressure and TCD flow velocity recordings was seen to diminish, rendering the calculation of Mx unreliable after acetazolamide. CONCLUSION: The measurement of Mx offers a noninvasive, safe technique for assessing abnormalities of pressure autoregulation in patients with carotid arterial disease.     

THE EFFECT OF ACETAZOLAMIDE ON POSTPERFUSION METABOLIC ALKALOSIS: A Controlled Clinical Study

A study was undertaken to evaluate the effect of the carbonicanhydrase inhibitor, acetazolamide, on postperfusion metablicalkalosis. In a series of twenty patients undergoing singlyStarr valve replacement for acquired heart disease, ten patientsacted as controls while the remainder received acetazolamide250 mg on termination of surgery and again on the morning ofthe first postoperative day. Mean postoperative base excessand pH of urine in the control goup showed a moderate metabolicalkalosis and progressive urinary acidity throughout the periodof study. In the acetazoamide group, mean base excess was significantlyless and mean pH of urine significantly higher 6–7 hoursafter operation and in the first postoperative day. Confirmationof the urine pH findings was obtained from collections of urinetaken at specified intervals. In general, the typical postoperativepattern of low sodium and chloride and increased potassium excretionwas observed in the urine collections. The relationship of theurinary electroytes is discussed. It is suggested that acetazolamidetherapy is a useful method of reducing an undue elevation ofpostoperative base excess.     

The effect of acetazolamide on intra‐ocular pressure after Trendelenburg positioning – a randomised double‐blind crossover trial in volunteers

Recent evidence suggests Trendelenburg positioning can produce a significant rise in intra‐ocular pressure. Peri‐operative vision loss in patients undergoing laparoscopic colorectal surgery has been reported with the rise in intra‐ocular pressure suggested as a possible factor. Acetazolamide decreases intra‐ocular pressure by reducing the formation of aqueous humour, so we aimed to investigate if it could attenuate the intra‐ocular pressure rise that can occur in the Trendelenburg position. Nine healthy volunteers were recruited and randomly assigned to a double‐blind crossover comparison of placebo or acetazolamide with a minimal 4 days’ washout period before the second study day. One and a half hours after taking the medication, volunteers lay head‐down at 17° for 4 h. Intraocular pressure measurements were repeated in both eyes every 30 min over a 4‐h period. There were two males and seven female volunteers, with a mean (SD) age of 54.3 (18.5) years. The mean (SD) increase in intra‐ocular pressure following 4 h in the Trendelenburg position was 3.17 (4.63) mmHg after the placebo, and 0.02 (4.01) mmHg (p = 0.02) after acetazolamide. We have shown than acetazolamide can attenuate the rise that occurs in intra‐ocular pressure when in the Trendelenburg position.     

Traumatic pseudoaneurysm of a pulmonary artery: anesthetic considerations

The authors determined the pharmacokinetics of fentanyl 100 micrograms X kg-1 iv in patients undergoing elective abdominal aortic surgery. The mean (+/- SD) age of the ten patients was 67.2 +/- 8.7 yr; their mean weight was 78.5 +/- 13.7 kg. Seven patients had aortic aneurysm repair, and the other three patients had aortobifemoral grafts. Serum fentanyl concentrations were determined from samples drawn at increasing intervals over a 24-h period. A three-compartment pharmacokinetic model was fit to the concentration versus time data. Total drug clearance was 9.8 +/- 1.8 ml X min-1 X kg-1. The volume of distribution at steady-state (Vdss) was 5.4 +/- 1.9 X 1 kg-1. Elimination half-time was 8.7 +/- 2.5 h. There were no significant correlations between these pharmacokinetic parameters and patient's age, duration of aortic cross-clamping, duration of surgery, intraoperative blood loss, or volume of iv fluids given intraoperatively. In healthy volunteers or patients undergoing general surgery, other investigators report mean elimination half-times for fentanyl ranging from 1.7 to 4.4 h. The prolonged elimination half-time in patients having abdominal aortic surgery has important clinical implications. In particular, recovery from large doses will take much longer than would have been anticipated from previously published fentanyl pharmacokinetic data.     

Measurement of cerebral blood flow by single photon emission computed tomography in cases of internal carotid artery occlusion

Cerebral blood flow (CBF) was measured with 133xenon inhalation and single photon emission computed tomography in 33 cases of internal carotid artery occlusion, in the resting state and 25 minutes after acetazolamide (Diamox) administration. The patient population consisted of 24 males and nine females with a mean age of 57 years, who presented with transient ischemic attacks or stroke. Acetazolamide inhibits carbonic anhydrase, and CBF increases as a result of dilatation of cerebral arteries due to CO2 accumulation. The mean CBF was 46 ml/100/g/min on the affected hemisphere and 56 ml/100/g/min on the unaffected hemisphere. The mean CBF value obtained by the same method in 10 normal volunteers was 55 ml/100/g/min. Thus, in the patients, CBF decreased on the affected side. The average increase in CBF after acetazolamide administration was 9% on the affected side and 17% on the unaffected side. The average increase in 10 normal volunteers was 32%. The reduced cerebral arterial reactivity to acetazolamide administration was bilateral in the patient group, which suggests that the cerebral arteries were dilated in order to maintain normal CBF. Extra-intracranial (EC-IC) bypass surgery was performed in nine patients. Preoperatively, the mean CBF was 48 ml/100 g/min on the affected side and 57 ml/100 g/min on the unaffected side; the postoperative CBF was 48 ml/100 g/min on the affected side and 56 ml/100 g/min on the unaffected side. Thus, there was no notable change in CBF on either side after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)     

Design and trial of a metronidazole loading dose regimen for patients undergoing emergency surgery

A dosing regimen for administration of metronidazole to patients undergoing emergency surgery was designed using pharmacokinetic data. Computer estimates of the pharmacokinetic parameters from normal volunteers were used to determine a loading dose protocol that would achieve plasma metronidazole levels above 6.2 micrograms/mL, that is, above the minimum inhibitory concentration (MIC) of most pathogenic anaerobic bacteria, at the time of surgery. The protocol aimed to identify the minimum intravenous metronidazole dose in combination with a rectal suppository regimen. This was calculated to be a 1 g (two 500 mg) metronidazole rectal suppository dose administered when the decision to operate was made, followed by a 200 mg intravenous dose at the induction of anaesthesia if the time to surgery was within 1-8 h. This protocol was tested in 10 patients undergoing emergency abdominal/pelvic surgery. All patients in the trial were found to have levels well above the MIC at the time of surgery (mean = 17.06 micrograms/mL, s.d. = 4.76). It is concluded that appropriate use of metronidazole suppositories can minimize intravenous dosage requirements for metronidazole under conditions of emergency loading as well as elective surgery.     

Cerebral blood flow in the determination of vasospasm and surgical decision]

The interest of C.B.F. studies performed on patients with subarachnoid haemorrhage is discussed on the basis of the literature and of our experience of 142 cases. C.B.F. results in basic condition are influenced by many factors which make its use very limited and especially during the first days after haemorrhage (J0-J3). However, the analysis of the evolution of C.B.F. values in the same patient and moreover the C.B.F. reactivity to acetazolamide are good indicators of the occurrence of a vasospasm; progressive drop of the C.B.F. or poor reactivity are generally observed before clinical signs of vasospasm. Our policy is therefore to decide the date of surgery according to C.B.F. values but only for patients planned for delayed surgery (after the 3rd day).     

Evaluating the accuracy of using population pharmacokinetic data to predict plasma concentrations of alfentanil

A major reason for quantitating the relationship of drug dose to plasma concentration is to design optimal drug administration schemes (i.e., those that can achieve desired target concentrations of a drug). Recently, the authors completed a population pharmacokinetic analysis of the new opioid alfentanil using the computer program NONMEM. This analysis quantified the effects of age, weight, and sex on disposition of alfentanil in 45 patients, and determined the average pharmacokinetic profile of the drug for the group. Using these population pharmacokinetic parameters, one can predict (estimate) the plasma concentration time course of alfentanil for any given dosage scheme. The present study evaluated the accuracy with which one could use these population data to predict plasma concentrations of alfentanil in a different group of surgical patients given iv boluses and a variable-rate infusion of alfentanil for induction and maintenance of anesthesia for abdominal and superficial surgery. A total of 597 plasma concentrations of alfentanil were measured for 19 patients. For each measured concentration, we used the population pharmacokinetic parameters obtained previously with NONMEM to calculate a predicted concentration. Accuracy and precision of the prediction were assessed by the mean bias of the prediction and by the mean absolute prediction error, respectively. The mean bias (+/- SE) (systematic over- or underprediction) was -7.9 +/- 5.2%. The mean absolute error (+/- SE), a measure of the precision, was 22.3 +/- 2.9%. Therefore, the authors' previously described population pharmacokinetic parameters for alfentanil appear to be "robust," and can be used to design computerized schemes for administration of alfentanil for general surgery.     

Acetazolamide reduces postoperative pain following laparoscopic inguinal herniorrhaphy

Background

Carbonic acid accumulation, which results from CO₂ insufflation, can produce visceral and referred pain in the postoperative setting. Acetazolamide inhibits carbonic anhydrase, an enzyme that accelerates carbonic acid formation. We hypothesized that preoperative administration of acetazolamide would decrease postoperative pain in patients undergoing laparoscopic inguinal herniorrhaphy.

Methods

A retrospective review was conducted of patients who underwent laparoscopic preperitoneal inguinal herniorrhaphy at the Medical College of Wisconsin between October 2012 and September 2014. Beginning in January 2014, patients began receiving 250 mg of acetazolamide preoperatively; patients prior to that time did not. The visual analog scale (range 0–10) was used to assess both preoperative pain and postoperative pain.

Results

A total of 66 patients underwent laparoscopic inguinal herniorrhaphy during the study interval. Of these, 22 (33 %) patients received acetazolamide preoperatively, and 44 (67 %) were included as controls. Overall mean pain scores were lower in the acetazolamide group (1.9 ± 1.45 vs 2.9 ± 1.5, p = 0.04). Specifically, patients who received acetazolamide reported lower pain scores immediately after surgery (0.6 ± 1.2 vs 1.9 ± 2.3, p = 0.01) and on post-op day one (2.3 ± 0.9 vs 4.0 ± 2.1, p = 0.04). Total morphine equivalents administered to manage postoperative pain were significantly less for the acetazolamide group (4.3 ± 4.8 mg) when compared to the control group (8.9 ± 8.4 mg), p = 0.04. Perioperative complications did not differ between the groups (p = 0.16).

Conclusions

Acetazolamide appears to reduce pain in the immediate postoperative setting. Patients who received acetazolamide had lower pain scores postoperatively and required fewer narcotics for pain management prior to discharge.