Efficacy of Abdominal Drains Placement Under Local Anaesthesia in High Risk Patients (ASA-4) with Generalized Peritonitis.

Abstract

Background: The surgical management of patients with peritonitis is complex and demanding. The patients are prone to have high morbidity and mortality. The surgical procedure under general anesthesia may worse the outcome. Objective: To determine the efficacy of two drains placement under local anaesthesia in patients with the diagnosis of peritonitis requiring exploratory laparotomy. Methodology: This was study on 84 patients from January 2013 to July 2019 with generalized peritonitis. The patients required surgical intervention but were unfit having ASA 4. After making the diagnosis, two drains were placed in abdominal cavity under local anaesthesia. First drain was placed in the lumbar area anteriorly while second drain placed in between the umbilicus and the symphisis pubis. Other treatment measures were done as per standard protocol. Post procedure outcome included cure of the patients, improvement and fitness for general anesthesia, deterioration of the condition or death. Results: Out of all patients, 55(65.47%) were male while 29(34.53%) were female. In all patients, there was remarkable decrease in abdominal distension immediately after drain placement. The 69 (82.14%) patients showed improvement in clinical and biochemical parameters within 24 hours. Nineteen (22.62 %) patients were cured and did not require laparotomy .Fifty one (60.71%) improved and underwent laparotomy. The mortality occurred in 14 (16.66%) patients. Conclusion: Peritoneal drainage and lavage by using two drains under local anesthesia and lavage is safe and effective in unfit patients with peritonitis.