2nd Hour Research Articles

OR-026 Exercise induces HIF-1α redistribution in the small intestine

Objective Intestinal epithelial cells are positioned between an anaerobic lumen and a highly metabolic lamina propria, affected by reduced blood flow and tissue hypoxia. Exercise induces blood flow redistribution, leading to hypoperfusion and gastrointestinal (GI) compromise. The hypoxia-inducible factor (HIF) 1α is pivotal in the transcriptional response to oxygen flux. In this study, we hypothesized that exercise induces GI system hypoxia and accumulates HIF-1α.
 Methods (1) ROSA26 ODD-Luc/+ mouse model (ODD-Luc) was used to detect HIF-1α expression in the intestine (female, 8-week, n=6/group). ODD-Luc mice were randomized into 4 groups: stayed in 21% O2 as the normoxic control (C), exercise (E), injected HIF-1α inhibitor PX-478 before swimming (PS), placed in the chamber containing 9% O2 for 4 hours as the positive control (PC). (2) Exercise models were conducted by volume: Moderate Exercise (ME): mice voluntarily swam for 30 min; Heavy-intensity Exercise (HE): mice swam for 1.5 hours with 5% body weight loads attached to their tails; Long-time Exercise (LE): mice voluntarily swam for 3 hours or till fatigue.
 Results (1) Exercise increased HIF-1α in the abdominal area. The luciferase activities boosted after exercise, compared to the controls (ME v.s. C, P<0.05; HE v.s. C, P<0.05; LE v.s. C, P<0.05) but no differences among three exercise groups (ME v.s. HE, P>0.99; ME v.s. LE, P>0.99; HE v.s. LE, P>0.99); (2) Exercise altered HIF-1α distribution in the small intestine in a time-dependent manner. The expression of HIF-1α was significantly increased after exercise and gradually reduced to the rest level. The photons increased at the 0th hour after exercise compared to that of the normoxic control (P<0.01). The level of photons then reduced over time, while the 2nd, 4th and 6th hour post-exercise were still greater than that of the normoxic control (2nd hour v.s. C, P<0.01; 4th hour v.s. C, P<0.01; 6th hour v.s. C, P<0.05), and returned to normal after 24 hours (24th hour v.s. C, P>0.99).
 Conclusions Exercise induced the distribution of HIF-1α in the small intestine. The expression of HIF-1α is shown in a time-dependent manner after exercise.

Dexmedetomidine with magnesium sulphate as adjuvants in caudal block to augment anaesthesia and analgesia in paediatric lower abdominal surgeries

PurposeTo investigate the implication of dexmedetomidine and magnesium sulphate addition to bupivacaine in caudal anesthesia in paediatric lower abdominal surgeries.Study designRandomized controlled trial.SettingPaediatric University Hospital.Subjects120 children undergoing surgeries in the lower half of the body under general anaesthesia with a supplementary caudal block using 1 ml/kg bupivacaine 0.25%.MethodsParticipants were randomly allocated into four groups; group C (saline as an additive to bupivacaine), group MG (50 mg magnesium sulphate added to bupivacaine), group D (1 µg/kg dexmedetomidine added to bupivacaine), and group MGD (the same doses of both dexmedetomidine and magnesium sulphate were added to bupivacaine). Time to first analgesia request (1ry outcome), and pain assessment by The Face, Legs, Activity, Cry, Consolability (FLACC) score just after recovery, then every 30 min in the early two hours, then at the 4th, 6th, 12th,18th, and 24th hours were compared between the groups.ResultsTime to first analgesia request was significantly longer in the three study groups compared to group C with p < 0.001 (median values of 5, 14.5, 13.5, and 20.47 h in groups C, D, MG, and MGD in consequence). FLACC scores were significantly higher in group C in comparison to the other study groups by the early 2nd, 4th, and 6th postoperative hours. The group MGD has significantly lowest FLACC at the 6th postoperative hour.ConclusionThe combination of dexmedetomidine and magnesium sulphate with bupivacaine caudal block can prolong the time to first analgesia request.

Efficacy of Music Therapy on Immediate Postpartum Episiotomy Pain: A randomized controlled trial

Objectives: To evaluate the effectiveness of music therapy in alleviating immediate postpartum episiotomy wound pain. Material and Methods: A randomized controlled trial was conducted to evaluate the efficacy of music therapy in alleviating immediate pain from an episiotomy wound. Uncomplicated singleton vaginal delivery women with the second degree or less episiotomy wound at Delivery and Postpartum Inpatient Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Srinakharinwirot University, Thailand were enrolled into the study. Visual analog scale (VAS) scoring was used for comparing pain levels. Results: One hundred postpartum women were enrolled in our study. Baseline characteristics such as age, degree of episiotomy wound tear were similar between both groups. The median pain VAS score was statistically significantly lower in the music group than in the control group at the end of the 2nd hour after finish of episiotomy wound repairing process [24.0 millimeters (8.3-41.5) and 36.5 millimeters (20.0-53.3), p < 0.001]. The median pain VAS score was statistically significantly lower in the music group than in the control group at the end of 6th hour after finish of episiotomy wound repairing process [12.0 millimeters (3.0-21.0) and 22.0 millimeters (15.0-38.0), p < 0.001] Conclusion: Music therapy is effective for reducing the perceived immediate postpartum pain of an episiotomy wound. Keywords: episiotomy pain, music therapy, singleton pregnancy

Ultrasound Guided Infraclavicular Block for Pain Control After Upper Extremity Surgery

Background: Opioids added to local anesthetics for peripheral nerve blocks may intensify analgesia and prolong analgesic and sensorial block duration. These agents may also cause potentiation and prolongation of motor block. Objective: This study compared the postoperative effects of 30 mL of 0.25% bupivacaine +50 mcg fentanyl and 30 mL of 0.25% bupivacaine + 100 mcg fentanyl solutions for the ultrasound-guided infraclavicular block in patients undergoing elbow and forearm surgery. Methods: In this randomized double-blind study, thirty-six patients with risk of ASA class I-III were randomly allocated into 2 randomized groups. Ultrasound-guided infraclavicular blocks with 30 mL of 0.25% bupivacaine + 50 mcg fentanyl for group 1 and 30 mL of 0.25% bupivacaine + 100 mcg fentanyl for group 2 were performed before patients emerged from general anesthesia. After surgery, pain levels at rest and during movement were evaluated using the 10-cm visual analog scale (VAS) at recovery room admission, at the 15th and 30th minutes in the recovery room, and at the 2nd, 6th, 12th and 24th hours postoperatively. Both morphine and rescue analgesic requirements were recorded. Sensorial and motor block durations, patient satisfaction, and complications related to the infraclavicular block were recorded. Results: In both groups, no significant difference in VAS pain scores, total morphine and total rescue analgesic requirements, duration of sensorial and motor block, or patient satisfaction were observed. None of the patients experienced any complications. Conclusion: The mixtures of 0.25% bupivacaine + 50 mcg fentanyl and 0.25% bupivacaine + 100 mcg fentanyl showed similar postoperative effects.

Effect of acupressure application to the P6 acupoint before laparoscopic cholecystectomy on postoperative nausea-vomiting: A randomized controlled clinical study

BackgroundNausea and vomiting are common postoperative complications that occur within the first 24 h in adults. Clinical practice guidelines and a Cochrane review recommend stimulating the P6 acupoint to prevent or reduce postoperative nausea and vomiting. However, there are currently no standards and optimal timing is not known. ObjectivesThe purpose of this study was to evaluate the effect of acupressure application on the P6 acupoint, using acupressure wristbands, in the prevention of postoperative nausea and vomiting and the antiemetic drug requirement in patients who had high postoperative nausea and vomiting risk related to laparoscopic cholecystectomy. DesignThis was a longitudinal, randomized controlled clinical study. SettingsThe study was conducted in the general surgery department of a training and research hospital (105 beds), from March 2015 to March 2016. ParticipantsA total of 111 female patients who underwent laparoscopic surgery were divided into three groups of 37, using a block randomization method. MethodsTraining on acupressure wristband use was provided to the intervention group and an acupressure wristband with a plastic cap was placed at the P6 acupoint. A wristband with the same appearance as the acupressure wristband, but without a cap, was used in the placebo group. No intervention was used in the control group. The wristband was placed approximately one hour before the surgery and removed six hours after the surgery in both the intervention and placebo groups. The data were collected at the 2nd, 6th, and 24th postoperative hours. ResultsThe application of the acupressure wristband to the P6 acupoint in patients who underwent laparoscopic cholecystectomy was found to be more effective in decreasing the severity of nausea at the 2nd postoperative hour and the nausea incidence at 2–6 h, postoperatively, when compared to the placebo group (p < 0.05). However, there was no statistically significant difference between the intervention group and the control group. Therefore, acupressure application to the P6 acupoint was not found to be clinically effective in decreasing postoperative vomiting, antiemetic drug requirement, and in decreasing pain, anxiety, or the need for analgesic drugs (p > 0.05). ConclusionsWe did not find the stimulation of the P6 acupoint with an acupressure wristband to be clinically effective in reducing postoperative nausea and vomiting or antiemetic drug requirement in patients who underwent laparoscopic cholecystectomy.

The impact of caudally administrated tramadol on immune response and analgesic efficacy for pediatric patients: a comparative randomized clinical trial.

BackgroundImmune responses appear to be affected by anesthetics and analgesics. We investigated the effects of caudal tramadol on the postoperative immune response and pain management in pediatric patients.MethodsSixty ASA-I pediatric patients aged 3–10 years undergoing lower abdominal surgery. Patients were randomly assigned either to a caudal bupivacaine (0.25%) group (group B), or a group that received caudal tramadol (1 mg/kg) added to the bupivacaine (0.25%) (group T). Both were diluted in a 0.9% NaCl solution to a total volume of 1ml/kg. The systemic immune response was measured by collecting blood samples preoperatively, at the end of anesthesia, and at 24 and 72 hours postoperatively, and studied for interleukin IL-6, C-reactive proteins (CRP) cortisol levels, and leucocytes with its differential count. Postoperative pain was assessed along with sedation scales.ResultsPostoperative production of IL-6 was significantly higher in group B at the end of anesthesia, than at the 24th hour, and at the 72nd hour in group B and group T, respectively. The immune response showed leukocytosis with increased percentages of neutrophil and monocytes, and a decreased lymphocyte response rate within both groups with no significant differences between the groups. Cortisol and CRP were significantly higher in group B.ConclusionsAdding tramadol to a caudal bupivacaine block can attenuate the pro-inflammatory cytokine response, Cortisol, and CRP in children undergoing lower abdominal surgery.

PET imaging of 68Ga-NODAGA-RGD, as compared with 18F-fluorodeoxyglucose, in experimental rodent models of engrafted glioblastoma

BackgroundTracers triggering αvβ3 integrins, such as certain RGD-containing peptides, were found promising in previous pilot studies characterizing high-grade gliomas. However, only limited comparisons have been performed with current PET tracers. This study aimed at comparing the biodistribution of 18F-fluorodeoxyglucose (18F-FDG) with that of 68Ga-NODAGA-RGD, an easily synthesized monomeric RGD compound with rapid kinetics, in two different rodent models of engrafted human glioblastoma.MethodsNude rodents bearing human U87-MG glioblastoma tumor xenografts in the flank (34 tumors in mice) or in the brain (5 tumors in rats) were analyzed. Kinetics of 68Ga-NODAGA-RGD and of 18F-FDG were compared with PET imaging in the same animals, along with additional autohistoradiographic analyses and blocking tests for 68Ga-NODAGA-RGD.ResultsBoth tracers showed a primary renal route of clearance, although with faster clearance for 68Ga-NODAGA-RGD resulting in higher activities in the kidneys and bladder. The tumor activity from 68Ga-NODAGA-RGD, likely corresponding to true integrin binding (i.e., suppressed by co-injection of a saturating excess of unlabeled RGD), was found relatively high, but only at the 2nd hour following injection, corresponding on average to 53% of total tumor activity. Tumor uptake of 68Ga-NODAGA-RGD decreased progressively with time, contrary to that of 18F-FDG, although 68Ga-NODAGA-RGD exhibited 3.4 and 3.7-fold higher tumor-to-normal brain ratios on average compared to 18F-FDG in mice and rat models, respectively. Finally, ex-vivo analyses revealed that the tumor areas with high 68Ga-NODAGA-RGD uptake also exhibited the highest rates of cell proliferation and αv integrin expression, irrespective of cell density.Conclusions68Ga-NODAGA-RGD has a high potential for PET imaging of glioblastomas, especially for areas with high integrin expression and cell proliferation, although PET recording needs to be delayed until the 2nd hour following injection in order to provide sufficiently high integrin specificity.

Influence of temsirolimus on antidiabetic effect of sitagliptin in experimental animal

The present study was carried out to evaluate the drug interaction between an antihyperglycemic agent and anticancerous drug,In healthy and Dexamethasone induced diabetic rats. The blood samples were collected up to 24 h and blood glucose level was estimated. In healthy albino rats Pretreatment with Temsirolimus (6.75 mg/kg for seven days) has significantly altered the onset of hypoglycemia (15.50+1.47 to21.40±.54), p&lt; 0.001 at the 2nd hour significantly enhanced the peak hypoglycemia (29.70+.60 %) before treatment to (44.47+1.21 %) after treatment(p&lt;0.001) at 4th hour (i.e. 18.71±.38 to 20.43±.89, p&lt;0.001 induced by Sitagliptin. Whereas in Dexamethasone treated rats, pretreatment with Temsirolimus (6.75 mg/kg) for 7 days has decreased the onset of hypoglycemia, significantly enhanced the peak hypoglycemia (24.13+.6417%) before treatment to (45.62+2.845 %) after treatment(P&lt;.001) at the 8th hour. This study indicates that therapeutic drug monitoring has been required for therapeutic doses of temsirolimus and antidiabetic drugs when used concomitantly.Highlights 1) Influence of Temsirolimus on hypoglycemic activity of Sitagliptin in healthy rats.2) Influence of Temsirolimus on hypoglycemic activity of Sitagliptin in Dexamethasone induced hyperglycemic rats.3) To suggest the alteration in the dose and frequency of administration of Oral antidiabetic agents when they are used along with Temsirolimus.Abbreviations P.o.- per os ‘by mouth’, DM-Diabetes mellitus,GOD-Glucose oxidase (GOD), POD- Peroxidase (POD).

Comparison of the effects of diclofenac potassium and tenoxicam on postoperative pain, swelling, and trismus following third molar surgery

Background/aim: This study aimed to compare two nonsteroidal antiinflammatory agents in relation to pain, swelling, and trismus following impacted third molar surgery. Materials and methods: The study was a randomized and a double-blinded study and included 50 healthy individuals. After the operation, patients were randomly assigned to 2 groups in which diclofenac potassium and tenoxicam were used. Impacted third molars were surgically extracted with local anesthesia. Pain was assessed postoperatively by visual analog scale at the 2nd, 6th, 8th, 12th, 24th, and 48th hours and on the 3rd, 5th, and 7th days. Swelling was evaluated using the method of Üstün et al. and trismus was measured with calipers on the postoperative 3rd and 7th days. Results: There was statistically significant difference between the groups in VAS levels at the 2nd and 6th hours; however, VAS levels of the tenoxicam group were significantly lower as compared to diclofenac potassium at the 8th, 12th, 24th, and 48th hours and on the 3rd, 5th, and 7th days (P < 0.05, P < 0.01). No difference was noted regarding trismus and swelling between the groups. Conclusion: Diclofenac potassium and tenoxicam are similarly effective for reduction of swelling and trismus following the extraction of mandibular third molars; however, tenoxicam surpasses diclofenac potassium for controlling pain.

Effect of different concentrations of hypertonic sodium fluid resuscitation on intestine injury in rats at the early stage of severe burn

To investigate the effect of different concentrations of hypertonic saline solution (HS) on intestine injury in rats at the early stage of severe burn. 104 adult healthy female Sprague-Dawley (SD) rats were randomly divided into five groups: sham group (n = 8), lactated Ringer solution (LR) group (n = 24) and 200, 300, 400 mmol/L HS group (HS200 group, HS300 group, HS400 group, all n = 24). All the rats in LR group and different concentrations of HS groups were scalded for 30% total body surface area (TBSA) with III degree, after immediately, the rats were given burn resuscitation therapy by LR or corresponding concentrations of HS through the tail vein. Eight rats were sacrificed on the 2nd, 8th and 24th post-injury hour (PIH), respectively, to collect abdominal aorta blood and intestinal tissues. The rats in sham group were given simulation of burns without resuscitation, which were immediately sacrificed and the specimens were harvested. The serum Na+ concentration was determined by automatic biochemical analyzer. Tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) contents in serum were determined by enzyme-linked immunosorbent assay (ELISA). The moisture content of intestine reflected by intestine wet/dry weight (W/D) ratio was determined. The content of malondialdehyde (MDA) and the activity of diamine oxidase (DAO) in intestinal tissue were determined by ultraviolet spectrophotometer. The activation of von Willebrand factor (vWF) was assessed by using immunohistochemistry. Compared with sham group, and the contents of TNF-α and IL-1β in blood and W/D ratio and MDA contents in intestine at each time point after injury in LR group and three HS groups were significantly increased, and the activity of intestinal DAO was significantly decreased. The serum Na+ concentration was significantly reduced in the LR group as compared with that in the sham group, which was significantly higher in the three HS groups than that in the sham group, with the most obvious change on the 8th PIH. Compared with LR group, the serum Na+ concentration and the activity of intestine DAO at each time point after injury in different concentrations of HS groups were significantly increased, and the serum contents of TNF-α, IL-1β and the W/D ratio, MDA contents in intestine were significantly lowered showing a dose dependent. The changes of HS400 group was the most significantly, and the difference on the 8th PIH was statistically significant as compared with LR group [blood Na+ (mmol/L): 145.51±0.72 vs. 131.52±0.85, intestinal DAO (U/g): 4.85±0.30 vs. 3.50±0.45, blood TNF-α (ng/L): 88.47±4.91 vs. 153.21±13.45, blood IL-1β (ng/L): 85.77±3.42 vs. 140.57±10.46, intestinal W/D ratio: 3.32±0.05 vs. 3.73±0.09, intestinal MDA (nmol/mg): 0.58±0.01 vs. 0.82±0.04, all P < 0.05]. The immunohistochemical results showed that the vWF activity in the LR group and different concentrations of HS groups was significantly reduced as compared with that of the sham group. Compared with LR group, the activity of intestinal vWF at each time point in different concentration of HS groups was increased to some extent with a dose dependent. The positive staining in HS400 group was the deepest, which showed that the activity of intestinal vWF was the strongest after treated by 400 mmol/L HS. Compared with LR, HS can attenuate intestinal tissue injury of rats at the early stage of severely burned, and of all, the curative effect of 400 mmol/L HS is the best.

Effect of oral ginger on prevention of nausea and vomiting after laparoscopic cholecystectomy: a double-blind, randomized, placebo-controlled trial.

BackgroundPostoperative nausea and vomiting (PONV) are among the most frequent complications following laparoscopic cholecystectomy. Recently, some studies have shown ginger, as an herbal medicine, to be effective and safe in PONV prevention; however, there is no evidence of its efficacy in the Iranian population.ObjectiveThe aim of this study was to determine the effect of oral ginger on PONV prevention after laparoscopic cholecystectomy.MethodsThis double-blind, randomized, placebo-controlled clinical trial was performed on women who were undergoing laparoscopic cholecystectomy in Imam Raza Hospital, Mashhad, Iran between April and November, 2016. Patients were divided randomly into two groups of G) intervention group (n=75, received 2 capsules containing 250 mg ginger) and P) placebo group (n=75, received 2 placebo capsules) one hour before surgery. Nausea severity and vomiting frequency were evaluated at 2, 4, 6, and 12 hours after the operation. Data analysis was done by SPSS version 16.0 software with Chi-square test, Independent-sample-t-test, repeated measure ANOVA and Mann–Whitney U test.ResultsThe two groups were homogenous in terms of age, gender and surgery duration. The severity of nausea was lower in the ginger group at the 2, 4, 6, and 12 hours after the operation; however, these differences were statically significant only at 2 (p=0.034) and 12 hours (p=0.043). Although the incidence of vomiting was higher in the placebo group in the 2nd and 12th hours after surgery, the number of vomiting episodes in 2, 4, 6 and 12 hours after surgery was statistically similar in the two groups (p>0.05). The nausea severity was significantly changed during 12 hours of study in both groups (p=0.001), however the nausea severity was always lower in the ginger group (p=0.078).ConclusionThis study demonstrated that 500mg oral ginger one hour before surgery in women who were undergoing laparoscopic cholecystectomy is effective in decreasing severity of PONV.Trial registrationThe trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT2016122222218N2.FundingThe study was financially supported by Deputy of Research of Mashhad University of Medical Sciences.

Predicting critical duration and reversibility of damage in acute mesenteric ischemia: An experimental study.

The objective of the current study was to investigate the value of the ischemic biomarkers endothelial cell-specific molecule-1 (endocan) and signal peptide-CUB-EGF domain-containing protein-1 (SCUBE-1) in the diagnosis and assessment of earlystage and irreversible damage in acute mesenteric ischemia. An experimental mesenteric ischemia reperfusion model was designed using 54 rats. Nine groups were created: Three sham groups [Groups I (30th minute), IV (2nd hour), and VII (6th hour)], in which only blood and tissue specimens were sampled; 3 ischemia groups [Groups II (30th minute), V (2nd hour), and VIII (6th hour)], in which blood and tissue specimens were sampled after ligation of the superior mesenteric artery (SMA); and 3 reperfusion groups [Groups III (30th minute), VI (2nd hour), and IX (6th hour)], in which blood and tissue specimens were sampled after declamping the SMA and reperfusion for 1 hour. SCUBE-1 and endocan samples obtained from blood and tissue were examined histopathologically. The SCUBE-1 level was higher in the ischemia groups when compared with the sham groups (p<0.05), and the endocan level was markedly different in the late ischemia (6th hour) group. When these 2 markers were used together to assess irreversible mesenteric damage in the histopathological examination, the sensitivity in distinguishing between reversible or irreversible damage was 94.1% with a specificity of 73.7%. The elevation of SCUBE-1 alone seems to be significant for predicting early mesenteric ischemia in laboratory rats. The combination of SCUBE-1 and endocan may be useful to detect irreversible intestinal damage.

Can Quercetin be an Option for Treatment of Spinal Cord Injury? An Experimental Study.

To determine the neuroprotective functions of quercetin and compare them with methylprednisolone in an experimental spinal cord injury model in rats. Thirty male, Wistar rats were assigned to five experimental groups: sham (n=6), trauma (n=6), methylprednisolone (n=6), single dose quercetin (n=6), and multiple doses of quercetin (n=6). An aneurysm clip compression method was used to produce spinal cord injury at level T7-9 after performing a laminectomy. In the sham group, only a laminectomy was performed. Clip compression was performed to the spinal cord after laminectomy in the trauma group. For Group 3, a single dose of intraperitoneal (ip) methylprednisolone (30mg/kg) was administered after laminectomy and trauma. A single dose of ip quercet in (100mg/kg) was administered after laminectomy and trauma in Group 4. For Group 5, multiple doses of ip quercetin (100 mg/kg) were administered on the first, second, and third days after laminectomy and trauma. Spinal cord and serum samples were obtained to measure the levels of malondialdehyde (MDA), nitric oxide (NO), total antioxidant levels (TAL) at the 72nd hour. Neurofunctional examinations of all the rats according to Drummond and Moore criteria and inclined-plane tests to evaluate functional healing were performed. All rats were sacrificed via intracardiac blood depletion after the procedure. Quercetin and methylprednisolone both increased plasma and tissue levels of NO and MDA, and decreased TAL, with a statistically significant difference (p < 0.05). NO and MDA levels in plasma and tissue were significantly higher in the trauma group (Group 2) when compared to the sham group (Group 1), and TAL levels were significantly lower (p < 0.05). There was a statistically significant increase in the treatment group's inclined-plane test (p < 0.05), while there was no difference in motor examination evaluations. The results of this experimental study suggest that quercetin can be thought as an option of treatment in spinal cord injury.

Postdural puncture headache: Incidence and predisposing factors in a university hospital.

Postdural puncture headache (PDPH) may occur 12-72 hours after spinal anesthesia. PDPH causes patient discomfort following spinal anesthesia and therefore it presents a challenging situation for anesthetists. This prospective randomized study enrolled 613 patients who were 18 years or older and who had been operated under spinal anesthesia. The spinal anesthesia procedure was performed with the patient in a sitting position through the L3-4, L4-5 interspaces, using 25 and 26 gauge (G) quincke and pencil-point spinal needles. The gender, age, body mass index, level of sensory block, mobilization time of the patients and also the experience and physical fatigue condition of the physicians were recorded. In the postoperative period all patients were questioned as to whether they experienced headache. These questions were repeated at postoperative 1st, 24th, 48th and 72nd hours in the hospital and on the 7th day by phone after they were discharged. Compared to older patients, patients between the ages of 25 to 40 (p<0.001) and compared to other operations, C/S patients (p: 0.003) experienced headaches more frequently in the postoperative period. The other two important factors were the experience (p: 0.013) and the physical fatigue of the physician (p: 0.001) on the day of surgery. The experience and good physical condition of the physician, TUR or anorectal surgery, a patient over 40 years of age and using pencil-point spinal.

Can Perfusion Index be used as an Objective Tool for Pain Assessment in Labor Analgesia?

Objective:To establish a relationship between the Visual Analog Scale for pain (VAS) in the recovery time of epidural analgesia and the Perfusion Index (PI) values at that time and to test the possibility of using PI as an objective tool for pain assessment.Methods:Thirty women were included in the study. After inserting epidural catheter, the initial applicationtime of epidural analgesia was taken as 0th minute. Hemodinamics, VAS, and PIvalues were recorded at 5th, 10th, 30th, 60th minutes and every two hours until the birth and the 30th minute after the birth.Results:HR, SAP, DAP, PI, VAS values before the procedure were different than all follow-ups (p<0.001). A negative and significant correlation was found at 10th, 30th, 60th minutes and 2nd hour after drug administration from epidural catheter(rho:0.38; p:0.03, rho:0.47; p:0.009, rho:0.75; p<0.001, rho:0.46; p:0.009, respectively). As the pain decreased, the perfusion index increased. In 17 patients requiring additional doses, PI increased after the all medications, but a decrease was observed in the VAS values(p<0.05).Conclusions:In this study, it was determined that the pain decreased with epidural analgesia, perfusion index increased and the pain level increased significantly when the perfusion index started to decrease.

The efficacy of diclofenac for post caesarean section analgesia: Comparison of rectal and intramuscular routes

Background: Despite advances in postoperative pain therapy, pain relief may still be inadequate for a substantial number of women.Aim: The aim was to compare the analgesic efficacy of rectal and intramuscular diclofenac for post Caesarean section analgesia.Materials and Methods: Following approval from the Hospital Ethics Committee 94 ASA I and II parturients aged 18 years and above scheduled for elective Caesarean section under spinal anaesthesia were recruited into the study. While one group of parturients received 100 mg Diclofenac suppository rectally (group R) those in the other group received 75 mg Diclofenac intramuscularly (group IM) immediately after surgery. The patients were instructed to request analgesic when they felt pain post-operatively. Pain scores were recorded using the VAS (0 to 10), (0 = no pain, 10 = the most severe pain), initially every 30 minutes for the first 2 hours, then every 2 hours from the 2nd hour to the 8th hour and every 4 hours after the 8th hour till the 24th hour.Results: The demographic data, BMI, PCV and ASA classification between the two groups of patients were comparable; the two groups were also comparable in the haemodynamic variables (mean systolic BP, mean diastolic BP, mean MAP and mean heart rate) and in the mean SpO2 recorded in the recovery room, p > 0.05 for all the variables. The time to first analgesic request in group IM was 313.2 ± 218.8 mins and in group R 314.1 ± 121.6 mins, p=0.98. There was no significant difference between the IM/R groups in the mean VAS scores of patients, the number of patients who received pentazocine at each time interval in the two groups, and the total pentazocine consumption in the two groups in 24 hours, p>0.05 in all the variables. There was no significant difference between the two groups in the mean satisfaction score in pain relief, p = 0.73, the mean satisfaction score with staff's response to patient's pain management needs, p = 0.85, and the mean acceptability score, p = 0.62.Conclusion: Suppository diclofenac administered through the rectal route is as efficacious as intramuscular diclofenac injection for post Caesarean section analgesia with equal levels of patient satisfaction and acceptability.Keywords: Post Caesarean section analgesia, diclofenac, rectal, intramuscular, spinal anaesthesia,

Butorphanol in Labour Analgesia

Labour is the process where uterine contractions lead to expulsion of product of conception through the vagina into the outer world. Labour pain is one of the most severe pains which has ever been evaluated and its fear is one of the reasons women wouldn't go for natural delivery. Delivery is a painful experience for all of the women except a few of them. The labor pain results from some physiological-psychological causes. Different pharmacological and non-pharmacological methods have been tried for pain relief in labour. The objective of this study is to see the effect of butorphanol injection in labour pain. It is a descriptive cross-sectional study conducted in B.P. Koirala institute of health sciences. We observed 200 pregnant women meeting the inclusion criteria and giving the informed consent who were on 1 mg butorphanol i.m. at the onset of active stage of labour every 4 hourly and on demand. Pain assessment was done by Numerical Pain analogue scale measured from 1 to 10. Fetal heart rate monitoring was done according to the hospital protocol. Caesarean section was performed for obstetrical indication. Neonatal outcome was evaluated by on duty pediatrician and APGAR score were noted at 1 and 5 min. The pain scores in first, second, third, fourth hour were (8.83±0.773), (9.84±0.544), (9.94±0.338), (9.6±0.298) respectively, where 1st and 2nd hour is statistically significant. Butorphanol is an effective labour analgesia without significant adverse effects on women and the neonatal outcome.

Sublingual buprenorphine versus intravenous morphine as a premedicant and postoperative analgesic in laparoscopic appendectomy under general anesthesia—A randomized control trial

Background: Minimally invasive surgery aims to minimize trauma, cause rapid mobilization, and thus achieve a satisfactory therapeutic result. But the challenging fact with the laparoscopic surgery is its hemodynamic changes because of pneumoperitoneum and the complex visceral pain in the postoperative period. Aim: To find a safe, reliable, and highly effective drug as a premedicant in laparoscopic appendectomies under general anesthesia. Materials and Methods: A total of 110 patients undergoing laparoscopic appendectomies were randomized into two groups: group M (morphine) and group B (buprenorphine) with 55 patients in each group. Group B patients received 0.4 μg of buprenorphine tablet sublingually 1 h before surgery and group M patients received 0.1 mg/kg of intravenous morphine 10 min before anesthesia induction. Intraoperative hemodynamics, postoperative pain score, rescue analgesic requirement, and complications were recorded. Results: Intraoperative vitals that is heart rate and mean arterial pressure were significantly stable in group B compared to group M. Only 11 % patients in group B required dexmedetomidine infusion compared to 37% in group M, to control intraoperative hypertension. Visual analog scale (VAS) values in group B at 2nd (1.30 ± 0.46), 4th (1.31 ± 0.54), and 6th hour (1.33 ± 0.63) were significantly less than group M at 2nd (4.56 ± 0.65), 4th (5.68 ± 0.72), and 6th h (4.45 ± 1.15). Duration of analgesia in postoperative period in group B (260.0 ± 28.52 min) was significantly longer than group M (124.10 ± 20.832 min). Conclusion: Sublingual buprenorphine premedication is an alternative to intravenous injection of morphine with perioperative hemodynamic stability and better postoperative analgesia.

Cardiovascular Haemodynamics and Some Biochemical Profiles of Endotoxemic Buffalo Calves on Infusion of HSS, Flunixin Meglumine &amp;amp; Blood

Six apparently healthy male buffalo calves aged between 6 months to one year with body weight range of 70 - 140 Kg were used in the present investigation. One animal was used for pilot trial for this group. Five calves were randomly taken into this group. The Eschrechia coli endotoxin infused i/v @5 mg/kg BW/hr for 3 hours to all the animals caused symptoms of restlessness, respiratory distress, snoring, diarrhea, profuse salivation along with the significant fall in systolic, diastolic, pulse and mean arterial venous pressure, hypoproteinemia at 1, 2 & 3 hour and hypoglycemia at 3rd hour i.e., end of endotoxin infusion. Respiration was increased significantly during endotoxin infusion at 2nd & 3rd hour and even afterwards till the end of the observation period i.e. 7 hrs. The treatment with hypertonic saline solution, flunixin meglumine and blood raised (p th, 6th & 7th hour respectively i.e., till the end of the observation period. There was no significant effect on Central Venous Pressure (CVP) and body temperature as measured from rectum.

A Comparative Study of Transversus Abdominis Plane Block versus Quadratus Lumborum Block for Postoperative Analgesia following Lower Abdominal Surgeries: A Prospective Double-blinded Study.

Context:Traditional truncal blocks are devoid of visceral analgesia. Quadratus lumborum (QL) block has shown greater efficacy in providing the same.Aims:This study was done to compare the efficacy of transversus abdominal plane (TAP) block versus QL block in providing postoperative analgesia for lower abdominal surgeries.Settings and Design:This was a prospective, randomized, double-blinded study.Subjects and Methods:Seventy adult patients were randomly allocated into two groups, where Group A received TAP block with 20 ml of 0.25% ropivacaine on each side (n = 35) and Group B received QL block with 20 ml of 0.25% ropivacaine on each side (n = 35). The time of block, duration of surgery, Numerical Pain Intensity Scale (NPIS) score at the 1st, 2nd, 4th, 8th, 12th, 16th, and 24th postoperative hours, and the total analgesic drug requirements were noted and compared between the two groups.Statistical Analysis Used:Data were analyzed with SPSS version 23 (IBM corporation, Armonk, NY, USA) with independent t-test and Chi-square test as appropriate. P < 0.05 was considered statistically significant.Results:The time for first analgesic requirement was 243.00 ± 97.36 min and 447.00 ± 62.52 min and the total analgesic consumption (morphine in mg) was 5.65 ± 1.55 and 3.25 ± 0.78 in Group A and Group B, respectively, both of which were statistically significant (P < 0.01). There was a significant difference in postoperative pain scores (NPIS scale 0–10) at rest, between the two groups, up to 16 h.Conclusions:Patients who received QL block had a significant improvement in postoperative pain relief with reduced consumption of opioids.