Hours In Group Research Articles

Adding Ketamine to Epidural Morphine Does Not Prolong Postoperative Analgesia After Lumbar Laminectomy or Discectomy.

Epidural opioids provide effective postoperative analgesia after lumbar spine surgery. Ketamine has been shown to reduce opioid-induced central sensitization and hyperalgesia. We hypothesized that adding ketamine to epidural opioids would prolong the duration of analgesia and enhance analgesic efficacy after lumbar spine surgery. American Society of Anesthesiologists physical status class I to II patients aged between 18 and 70 years with normal renal function undergoing lumbar laminectomy were recruited into this single-center randomized trial. Patients were randomized to receive either single-dose epidural morphine (group A) or epidural morphine and ketamine (group B) for postoperative analgesia. The primary objective was to compare the duration of analgesia as measured by time to the first postoperative analgesic request. Secondary objectives were the comparison of pain scores at rest and movement, systemic hemodynamics, and the incidence of side effects during the first 24 hours after surgery. Fifty patients were recruited (25 in each group), of which data from 48 were available for analysis. The mean±SD duration of analgesia was 20±6 and 23±3 hours in group A and group B, respectively ( P =0.07). There were 12/24 (50%) patients in group A and 17/24 (71%) patients in group B who did not receive rescue analgesia during the first 24-hour postoperative period ( P =0.07). Pain scores at rest and movement, systemic hemodynamics, and postoperative complications were comparable between the groups. The addition of ketamine to epidural morphine did not prolong the duration of analgesia after lumbar laminectomy.

Left internal mammary on-lay patch vs. saphenous vein patch in reconstructing diffusely diseased left anterior descending artery

Background: Several operative techniques were described to reconstruct the diffusely diseased left anterior descending coronary artery (LAD). The superiority of the left internal mammary artery (LIMA) vs. the saphenous vein patch is controversial in LAD reconstruction. Thus, this study compared LIMA on-lay patch vs. saphenous vein patch in reconstructing diffusely diseased LAD artery.
 Methods: This study was conducted between June 2020 and May 2022 including 60 patients with a diffusely diseased LAD. LIMA patch was used in 30 patients (Group I) and saphenous vein patch in 30 patients (Group II) without endarterectomy. Males presented 85%; the mean age was 56.68 ± 6.44 years. The mean patch length in the LIMA group was 4.48±0.87 cm and 4.60± 0.93 cm in the saphenous vein group.
 Results: The mean aortic cross-clamp and cardiopulmonary bypass times were 66.80± 19.93 and 108.00± 25.74 minutes in the LIMA group and 84.40± 30.65 and 132.53± 45.41 minutes in the venous Group (P= 0.011 and 0.013, respectively). The mean intensive care unit stay was 50.40 ± 38.65 hours in Group I and 92.00± 51.62 hours in Group II (P˂ 0.001). Four patients (13.3%) needed an intra-aortic balloon pump (IABP) in Group I, and 11 patients (36.7%) in Group II (P= 0.037). Postoperative low cardiac output occurred in 13.3% of Group I and 53.3% in Group II (P= 0.001). Postoperative atrial fibrillation occurred in 13.3% of Group I, while in Group II was 33.3% (P= 0.067). The renal complications were 3.3% in Group I and 16.7% in Group II (P= 0.085). Two patients (6.7%) were complicated with bleeding in Group I, and nine (30.0%) in Group II (P= 0.02). The postoperative ejection fraction was 58.17± 5.25% in Group I and 53.3± 5.23% in Group II (P= 0.001). On the first postoperative day, the creatine kinase-myoglobin binding level was 61.73± 30.19 IU/L in Group I and 92.63± 45.88 IU/L in Group II (P= 0.004). Hospital mortality occurred in one patient (3.3%) in Group I and two in Group II (6.7%) (P˃ 0.99).
 Conclusion: LAD reconstruction using the LIMA patch could have better early outcomes than the saphenous vein patch.

Efficacy of Oral Gabapentin and Intravenous Paracetamol for Postoperative Analgesia in Laparoscopic Surgeries: A Prospective Randomised Double Blind Study

Background: Post-operative pain is a matter of great concern for anaesthesiologists and surgeons. We compared the efficacy of oral Gabapentin and intravenous Paracetamol for postoperative analgesia in patients undergoing laparoscopic surgeries.
 Methods: After obtaining written informed consent and ethical committee approval, a total of 70 patients undergoing laporoscopic surgeries were randomly allocated into two groups- 35 patients included in Group A were given 600 mg oral Gabapentin 2 hours before the surgery and Group B patients were given 1gm I.V. PCM 30 minutes before the surgery. The NRS scores at 30 min, 2 hours, 6 hours, 8 hours, 12 hours, and 24 hours were recorded. The time at which first rescue analgesic given and Different hemodynamic parameters like heart rate, blood pressure and oxygen saturation were also recorded at different time intervals.
 Results: NRS scores and MAP was higher in Group B with a significant p-value at 8 and 12 hours. The need of first rescue analgesic required was at 7.79±3.49 hours in Group A. In Group B requirement of first rescue analgesia was at 6.09±2.75 hrs. The total dose of tramadol used was significantly higher in Group B with mean 92.86±36.67 than Group A 64.29±28.62 with statistically significant p-value (p=0.001).
 Conclusion: Both oral Gabapentin and intravenous Paracetamol are effective modes of postoperative analgesia hence both can be used as preemptive analgesic agents. Oral Gabapentin has a longer duration of action up to 12 hours in the postoperative period while intravenous Paracetamol is effective up to 6 hours postoperatively.

Outcome of perioperative 24-hour infusion of intravenous lignocaine on pain and QoR-15 scores after breast cancer surgery-A randomised controlled trial.

Despite many analgesic modalities available, postoperative pain management after breast cancer surgery remains a challenge, which translates into poor quality of recovery, if untreated. Intravenous lignocaine with its anti-inflammatory, antihyperalgesic, and analgesic properties could provide a good option for these patients. The aim of this study was to evaluate the effect of intravenous lignocaine on postoperative pain relief and quality of recovery in patients undergoing surgery for breast cancer. In this prospective double-blind placebo-controlled randomised study, sixty-six patients undergoing breast cancer surgery were assigned 1:1 to placebo or intravenous lignocaine (Group L). Group L received an intravenous 1.5 mg/kg of lignocaine bolus at induction, followed by an intravenous infusion of 1 mg/kg/h for 24 hours intravenously, while the control group was given equal volume of normal saline. Pain scores, opioid utilisation, and quality of recovery (QoR-15) at 24 hours and on the day of suture removal were compared. Statistically significant reduction was observed in both static (P = 0.01, 6 hours) and dynamic postoperative pain (P = 0.030, 24 hours), with consequential delay in the need for the first dose of opioid (P = 0.014) as well as decreased 24-hour postoperative opioid consumption (P < 0.001) and decreased post-operative nausea and vomiting (PONV) (P < 0.05) in the lignocaine group. Global QoR-15 was significantly better at 24 -hours in group L on postoperative day 1 (P < 0.001), albeit there was no significant difference at suture removal. No lignocaine related side effects were observed. Intravenous lignocaine can be safely used as an alternative perioperative non-opioid analgesic for early postoperative pain and recovery.

Nitazoxanide in Acute Rotavirus Diarrhea- A Randomized Controlled Trial Study in a Tertiary Care Hospital in Bangladesh

Background: Acute rotavirus diarrhea is one of the leading cause of morbidity and mortality in children younger than 5 years. Nitazoxanide, an antiparasitic agent, acts by inhibiting the maturation of rotavirus viral protein 7 thus interferes with viral morphogenesis. Aim of the study: was to evaluate the role of nitazoxanide in the treatment of acute rotavirus diarrhea in 6 months to 2 years aged children. Methods: This randomized controlled trial was conducted at Bangladesh Shishu Hospital &amp; Institute, Dhaka, Bangladesh from June 2018 to July 2020. A total of 70 children with acute onset diarrhea of &lt;48 hours. duration was included in this study. All the studied patients were divided into two equal groups (group I and group II) by lottery, each comprising 35 children. The groupI represented the study group who received standard treatment of diarrhea plus oral nitazoxanide (15mg/kg/day) twice daily for 3 days and the group II is the control group received standard treatment only. Results: Study demonstrated that maximum number of patients 22 (31.4%) were between 14-17 months of age group and 36% patients came from rural, 64% from urban areas. Study showed before commencement of treatment most of the patients in both groups experienced some dehydration, vomiting, fever, &amp; abdominal distension. At 48 hours’ improvement was observed in both groups, comparatively higher in group I. Difference of some dehydration and vomiting improvement between two groups were statistically significant (p &lt;0.05). After 3 days’ treatment normal stool consistency was found in 24(68.5%) patients in group I &amp; 10 (28.5%) in group II patients. The difference was also statistically significant (p=&lt;0.05). Mean time of resolution of diarrhea 62.5 hours in Group-I and 96.5 hours in group-II. Compared to the group II, group I showed decrease in mean time of resolution of diarrhea (p= 0.001). The mean duration of hospital stay was prolonged in group-II (86.5 hours vs. 102.5 hours in group I &amp; II respectively), the difference was statistically significant (p˂0.05). Conclusion: In the present study, oral nitazoxanide was found effective in the treatment of acute rotavirus diarrhea in 6 months to 2 years old children.

Frequent body position changes and physical activity as effective as standard care for infants hospitalised with acute respiratory infections - a randomised controlled trial.

No definite consensus has been reached yet on the best treatment strategy for the large group of infants hospitalised with bronchiolitis or pneumonia. Minimal handling is often recommended, although not evaluated scientifically. There is a need to evaluate the management, as the infants often are critically affected, and the costs for society are high. The aim of this RCT was to evaluate the most common physiotherapy intervention in Sweden for this patient group, including frequent changes in body position and stimulation of physical activity, compared to standard care. Infants 0-24 months old, without previous cardiac or respiratory diagnoses and born in gestational week 35+, were recruited in two Swedish hospitals. The participants (n=109) were randomised to either interventions in addition to standard care (intervention group) or to standard care alone (control group). The primary outcome measure was time to improvement. The secondary outcomes were immediate changes in oxygen saturation, heart rate and respiratory rate, time to improved general condition (parents' assessment), and lung complications. The median time to improvement was 6 hours in both groups (p=0.54). The result was similar when we adjusted for age in months, sex, tobacco smoke exposure, heredity for asthma/atopic disease, and early stage of the infection (for those with RSV), p=0.69. Analyses of the immediate changes showed no significant differences either (p=0.49-0.89). Time to improved general condition was median 3 hours in the intervention group and 6 hours in the control group, p=0.76. No lung complications occurred. No statistically significant differences in outcomes were detected between the intervention group and the control group. Both strategies were found to be equally effective and safe, indicating that the current recommendation of minimal handling for these infants should be reconsidered. Furthermore, the findings suggest that this treatment can be safely continued.

Efficacy of Gabapentin versus Combination of Dexamethasone-Ondansetron in Prevention of Postoperative Nausea and Vomiting in Middle Ear Surgery: A Randomised Clinical Study

Introduction: Postoperative Nausea and Vomiting (PONV) is the most common and unpleasant complication with incidence of 30-80% after elective surgery. Dexamethasone and Ondansetron (DO) combination has superior efficacy and is recommended as an ideal choice for prevention of PONV in Middle Ear Surgery (MES). Oral Gabapentin, an anticonvulsant has been introduced as an antiemetic to fast-track bundles and enhanced recovery after surgery. Aim: To compare the efficacy of DO with gabapentin monotherapy in prevention of PONV in patients undergoing MES. Materials and Methods: This randomised, double-blind, parallel group clinical study was done at Department of Anaesthesiology, St John’s Medical College, Bengaluru, Karnataka, India from November 2018 to March 2020. Sixty-six of patients were randomised to Group DO (Intravenous Dexamethasone at start and Ondansetron at end of surgery, 100 μg/kg each) and Group G (Oral Gabapentin 300 mg one hour prior to surgery). Postoperatively, incidence and severity of PONV, duration of antiemesis and analgesia, total rescue antiemetics and analgesics, along with side-effects were assessed for 24 hour period. Descriptive statistics was summarised for continuous (mean and standard deviation) and categorical (number with percentages) variables. Inferential statistics were depicted using Fisher’s-exact and Student’s t-test. Results: The demographic profile was comparable between the two groups. Incidence of PONV was significantly lesser in Group DO compared to the Group G (12% versus 36%, p-value=0.0129). Duration of antiemesis was four hours in Group DO and two hours in Group G was statistically significant (p-value=0.021). Severity of PONV was significant (p-value=0.033 and 0.009, respectively) at four and six hours between the groups. Duration of analgesia (6.28±5.96 in Group DO versus 5.62±3.63 hours in Group G; p-value=0.252), rescue analgesics and side-effects were comparable between the two groups (p-value&gt;0.05). Conclusion: In MES, DO combination reduced the incidence and severity of PONV and is better prophylactic antiemetic therapy than gabapentin alone.

Comparative study of induction of labour with oral mifepristone and intracervical dinoprostone in primigravida

Background: Mifepristone (RU-486) in doses of 200-400 mg has shown to improve cervical ripening. Hence the sequential use of Mifepristone followed by Dinoprostone is more effective in induction of labour with less chance of failed induction and thereby decreasing the caesarean delivery rate. Methods: A prospective comparative study was done for a period of 21 months from Oct 2021 to June 2020 in Dept. of OBG AIMS RC.170 primigravida with term gestation were included in the study.85 women (group A) were given 200 mg Mifepristone orally and 85 women (Group B) were induced with 0.5 mg intra cervical Dinoprostone gel. Bishop score was assessed after 6 hrs. Results: After the 1st assessment Bishop score was < 6 in 35.7% in group A, 28.8% in group B. Induction delivery interval was 9.61 hours in group A, 5.21 hours in group B (p≤0.001). 71.7% had vaginal delivery and 28.2% required LSCS in group A and 52.9% had vaginal delivery and 47.1% required LSCS in group B. There was no fetal mortality in both the groups Conclusion: Induction delivery interval was more in Group A compared to group B. However % of vaginal delivery was more in Group A compared to group B. Oral Mifepristone 200 mg can be used for cervical ripening during induction of labour, followed by intracervical Dinoprostone gel to reduce the number of caesarean deliveries.

Perioperative Intravenous Lidocaine Infusion for Postlaparoscopic Cholecystectomy Pain.

To compare intravenous lidocaine infusion adjunct to NSAID and Acetaminophen with regular analgesics for postoperative mean pain score and mean ambulation time after laparoscopic cholecystectomy. Randomised controlled trial. Department of General Surgery, Islamabad Medical Complex, (IMC), from March 2020 to December 2021. Sixty (n=60) adult patients, both males and females between the ages of 18-60 years planned for laparoscopic cholecystectomy, were selected and randomly allocated to two groups of treatment (Lidocaine and Ringer Lactate). The control group did not receive any other placebo other than Ringer Lactate infusion. Both groups received Intramuscular Diclofenac 12 hourly and intravenous acetaminophen infusion 8 hourly. Postoperative pain 2, 6, 12 and 24 hours (h) and mean ambulation time were compared in both groups. Mean VAS (Visual Analogue Scale) of group 1 versus group 2 at 2 h, 6 h, 12 h and 24 h were 3.47 ± 0.82 vs. 6.27 ± 0.52 (p=<0.001), 2.7 ± 0.75 vs. 4.8 ± 0.8 (p<0.001), 2.0 ± 0.49 vs. 3.93 ± 0.94 (p<0.001), 0.73 ± 0.82 vs. 2.2 ± 0.61 (p<0.001). Time for spontaneous ambulation after surgery was 5.57 ± 1.55 hours for Group 1 versus 7.3 ± 1.9 hours for Group 2 (p<0.001). Pain scores at all-time intervals were lower, and ambulation time was shorter in patients who received intravenous infusion of lidocaine as compared to patients who received only regular analgesics for laparoscopic cholecystectomy. Ambulation time, Laparoscopic cholecystectomy, Postoperative pain.

Collagen-Based Grafts and Autologous Dura Replacement in Patients with Dura Abnormalities: A Retrospective Comparative Evaluation

Introduction: Accidental spinal anomalies of the spinal dura mater are the source of cerebrospinal fluid (CSF) leakage. Typically, dura abnormalities are identified in 3 percent of endoscopic lumbar discectomy cases. Objective: The purpose of the current research was to evaluate the results of autologous dura replacement versus collagen-based grafts in individuals with dura deformities. Methods: The Institute of Neurosurgery at Liaquat National Hospital Karachi undertook this randomized evaluation to identify the most effective therapy for dura mater defects. Employing non-probability random selection, 82 cases among both sexes were selected. Participants were divided randomly into two subgroups i.e. Group 1A received an autologous graft for dura restoration, whereas Group 2B received a semi-synthetic dura replacement. A skilled surgeon led a medical team of six people who completed the entire process. Results: The operation duration for semi-synthetic collagen was significantly reduced. There was a 40 minute variation in total time spent by the two groups. Autologous grafts showed ideal tightness and better flexibility and fair workability on the other hand semi-synthetic collagen showed better tightness and workability and ideal flexibility. Postoperative hospital stays were seen to be 26 + 2.5 hours in Group 1A whereas they were 23 + 2.5 hours for Group B. Conclusion: According to the aforementioned findings, an accessible, secure, and efficient substitution for an autologous graft for dura restoration in dura abnormalities is the use of a semi-synthetic collagen substitute. Keywords: semi-synthetic collagen substitute, cerebrospinal fluid, dura abnormalities, autologous graft.

COMPARISON OF RACECADOTRIL WITH ORAL REHYDRATION SOLUTION IN ACUTE WATERY DIARRHEA UNDER 5 YEARS OF AGE

BACKGROUND: A significant share (18%) of paediatric mortality is caused by diarrheal diseases. Children under the age of five are most susceptible to viral diarrhoea. In cases of acute watery diarrhoea, racecadotril, an anti-secretory medication, can limit fluid and electrolyte loss from the intestine without compromising intestinal motility.&#x0D; OBJECTIVE: To compare the number of loose stools within the first 48 hours of admission between the children treated with and without Racecadotril, as well as the mean recovery time in children in both groups, in order to determine the efficacy of Racecadotril in treating acute watery diarrhoea in children aged 6 months to 5 years.&#x0D; METHOD: It was a Randomized Controlled Trial that ran from October 2020 to March 2021 at the Paediatrics Department at LGH/PGMI/AMC Lahore. Patients were divided into two equal groups at random using a computer-generated random number table. Racecadotril (1.5 mg/kg body weight, orally three times per day for 5 days or until diarrhoea ceases, whichever happens first) was given to 100 patients in group A coupled with Low Osmolality ORS, while Low Osmolality ORS was given to 100 patients in group B. For testing of blood haemoglobin, blood urea and creatinine, blood sugar, serum electrolytes, and stool (pH, microscopic inspection, culture, and sensitivity), blood samples were sent to a hospital pathology lab. As per operational definition, recovery time was documented.&#x0D; RESULTS: In our study, the mean recovery time was 37.88 hours in group A (racecadotril plus low osmolality ORS) and 47.40 hours in group B (low osmolality ORS), demonstrating a substantial reduction in recovery time of 20.08 percent (p value = 0.0026). The mean 48-hour stool frequency was 11.34 episodes in the Racecadotril + low osmolality ORS group and 14.98 episodes in the low osmolality ORS group, demonstrating a statistically significant decrease in stool frequency of 24.29 percent with the Racecadotril group (p value = 0.025). Faster recovery (20.08 percent) and a reduction of 20.52 percent in ORS consumption, which is comparable with earlier trials on Racecadotril conducted in children with acute watery diarrhoea.&#x0D; CONCLUSION: In managing children under the age of five who have acute watery diarrhoea, we came to the conclusion that there is a substantial difference in the mean recovery time when Racecadotril and Low Osmolality Oral Rehydration Solution (ORS) are used in combination

Pleural effusions are associated with adverse outcomes after cardiac surgery: a propensity-matched analysis

BackgroundPleural effusions commonly occur in patients recovering from cardiac surgery; however, the impact on outcomes is not well characterized. The purpose of this study is to characterize the clinical outcomes of cardiac surgery patients with pleural effusion.MethodsAll patients undergoing cardiac surgery between 2006 and 2019 at a tertiary care university hospital were included in this observational, cross-sectional analysis using propensity matching.ResultsOf 11,037 patients that underwent cardiac surgery during the study period, 6461 (58.5%) had no pleural effusion (Group 0), 3322 (30.1%) had pleural effusion only (Group 1), and 1254 (11.4%) required at least one secondary drainage procedure after the index operation (Group 2). After propensity matching, the mortality of patients who underwent secondary drainage procedures was 6.1% higher than in Group 1 (p < 0.001). Intensive care unit (ICU) stay was longer for those with pleural effusions (18 [IQR 9–32] days in Group 2, 10 [IQR 6–17] days for Group 1, and 7 [IQR 4–11] days for Group 0, p < 0.001). Patients with pleural effusions had a higher incidence of hemodialysis (246 [20.0%] in Group 2, 137 [11.1%] in Group 1, 98 [7.98%] in Group 0), and a longer ventilation time in the ICU (57 [IQR 21.0-224.0] hours in Group 2, 25.0 [IQR 14.0–58.0] hours in Group 1, 16.0 [IQR 10.0–29.0] hours in Group 0).ConclusionPleural effusions, especially those that require a secondary drainage procedure during recovery, are associated with significantly worse outcomes including increased mortality, longer length of stay, and higher complication rates. These insights may be of great interest to scientists, clinicians, and industry leaders alike to foster research into innovative methods for preventing and treating pleural effusions with the aim of improving outcomes for patients recovering from cardiac surgery.

Comparison between Fistulotomy vs Fistulotomy with Marsupialization in Simple Low Anal Fistulae: A Randomized Control Trial

Objective: To compare the efficacy of fistulotomy with marsupialization vs fistulotomy alone in the treatment of simple low lying anal fistula in terms of wound healing and postoperative pain. Study Design: Randomized control trial Place and Duration: Department of General Surgery, JPMC Karachi, duration of Study was 6 months from 23rd Aug 2020 to 23rd Feb 2021. Methodology: Sixty patients of either gender having ages 25-60 years presented with low anal fistula were included in this study. Detailed demographics were recorded after taking informed written consent from all the patients. Patients were divided in to two groups. Fistulotomy was performed on 30 patients in group A and fistulotomy with marsupialization was performed on 30 patients in group B. Patients were asked to choose envelop labelled treatment A and treatment B for the randomization. All patients were followed up on 24 hours after surgery and on weekly interval up to 4 weeks to determine the outcomes in terms of wound healing and pain score. Data was analyzed by SPSS 23.0. Results: In group A mean age of patients was 43.633+8.568 years while in group B mean age was 41.800+9.813 years. The mean Pain score after 24 hours in group A was 6.100+0.922 while in group B it was 5.033+0.718 with overall mean Pain score after 24 hours of 5.566+0.980. The mean Pain score after 5th day in group A was 4.266+0.639 while in group B it was 2.833+0.698 with overall mean Pain score after 5th day of 3.550+0.981. In Group A efficacy was achieved in 4 patients (6.7%) while in Group B efficacy was achieved in 14 (23.3%) patients. Conclusion: Marsupialization of the wound after fistulotomy for low anal fistula results in faster wound healing and less mean post operative pain as compare to fistulotomy alone. Keywords: Low Anal Fistula, Marsupialization, Fistulotomy, Pain, Wound Healing

EVALUATION OF CLINICAL AND LABORATORY FINDINGS OF PATIENTS APPLYING TO THE EMERGENCY DEPARTMENT DUE TO RENAL COLIC IN RAMADAN, A SINGLE CENTER STUDY

OBJECTIVE: We aimed to evaluate the demographic, laboratory and radiological results of patients who applied to the emergency department due to renal colic (RC) during Ramadan.MATERIAL AND METHODS: This retrospective cross-sectional study included patients applied to emergency department (ED) with a diagnosis of RC during 2019 Ramadan and the 1 month preceding Ramadan. Age, sex, the hour of application, the results of urinalysis (erythrocyturia, leukocyturia, ketonuria, and urine density), presence of stones on radiological imaging and the location of the stone in the urinary system were recorded. The patients were grouped into three groups as the patients in the month preceding Ramadan (Group 1, n=83); patients fasting in Ramadan (Group 2, n=55); and patients not fasting in Ramadan (Group 3, n=37).RESULTS: Of the study population, 52.6% applied in Ramadan and 47.4% in the preceding month. There was no significant difference between the groups with respect to mean age, urinary leukocytes, urinary ketone, presence of stones and location of stones (p&amp;gt;0.05). Urinary erythrocytes were significantly lower in Group 3. The proportion of men and frequency of patients' admission between 16-24 hours in Group 2 was higher than the other groups. Urine density of Group 1 was found to be significantly lower than groups 2 and 3, but there was no difference between groups 2 and 3.CONCLUSIONS: It was found that fasting patients applied to the emergency department most frequently between the hours of 4 p.m. and 12 a.m. due to renal colic. Urinary erythrocytes were found significantly less in Group 3. In addition, we think that the high urine densities of the patients who applied during Ramadan are not related to fasting but to the increasing air temperature.

Analgesic effect of intravenous versus intraperitoneal dexmedetomidine as an adjuvant to intraperitoneal bupivacaine (0.125%) in laparoscopic cholecystectomy: a randomized, double blind, interventional study

Background and Aims: Laparoscopic cholecystectomy has emerged as a gold standard technique for gall bladder stones. The aim of the present study was to compare the analgesic effect of intravenous (IV) vs intraperitoneal (IP) dexmedetomidine as an adjuvant to intraperitoneal (IP) bupivacaine in laparoscopy. Methods: A prospective, randomized, double blind, interventional study was conducted on 100 patients undergoing laparoscopic cholecystectomy where they were divided into following 2 groups: Group A: Patients received IV 1µg/kg dexmedetomidine diluted to 30 ml with normal saline over 10 min and 40 ml of 0.125% bupivacaine IP after removal of gall bladder. Group B: Patients received IV 30 ml of normal saline and 1µg/kg IP dexmedetomidine in 40 ml of 0.125% IP bupivacaine after removal of gall bladder. The primacy outcome was noted as a difference in mean duration for need of first rescue analgesia. The total consumption of analgesic in first 24hours was recorded and compared between the two groups. Results: Both the groups were comparable in terms of demographic profile and intraoperative hemodynamic parameters with no statistical difference. Comparison of time to first analgesic requirement between the two groups showed statistically significant results with unpaired t test The time of first rescue analgesia in Group A was 151.80 min ± 76.624. and in Group B was 94.80min ± 21.499. The total analgesic requirement in 24 hours in Group A was 136.64 ± 31.251 and in Group B was 144.12 ± 21.49. Conclusion: In our study we concluded that intravenous dexmetomidine provided superior analgesia as compared to intraperitoneal dexmetomidine when used as an adjuvant with Bupivacaine intraperitoneally.

Comparison Between The Effectiveness of Lateral and Posterior Transversus Abdominis Plane Block by Using Bupivacaine After Total Abdominal Hysterectomy.

Background: Transversus Abdominis Plane (TAP) block is a regional anaesthetic technique used for postoperative pain management following abdominal surgery. Local anesthetics like bupivacaine can be used in this block and it can be performed in various approaches. Among them ultrasound-guided lateral and posterior approaches are popular. Objective: Aim of this study is to compare the effectiveness of lateral and posterior approaches of ultrasound-guided TAP block using bupivacaine in the management of post-operative pain after total abdominal hysterectomy under subarachnoid anesthesia. Materials and Methods: This randomized clinical trial was carried out in the Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU) Dhaka. Total 90 patients were scheduled for elective total abdominal hysterectomy and assigned into two equal groups, group A and group B received ultrasound guided TAP block in lateral approach and in posterior approach respectively. Then patients were observed for pain intensity at rest and during deep breath by visual analog scale (VAS), after 1 hour, 2 hours, 4 hours, 6 hours, 12 hours and 24 hours of TAP block. The time of first analgesic demand was noted. Statistical analyses of the results were obtained by using window based computer software devised with Statistical Packages for Social Sciences (SPSS-22). Results: The mean pain intensity at rest and during deep breath was statistically significant (p&lt;0.05) at 4, 6, 12 and 24 hours after TAP between two groups. The mean duration of first analgesic demand was 5.04±0.54 hours in group A and 6.59±0.69 hours in group B was statistically significant (p&lt;0.05) between two groups. Conclusion: TAP block in posterior approach provided considerably effective postoperative analgesia in first 24 hours than lateral approach after total abdominal hysterectomy. KYAMC Journal Vol. 13, No. 02, July 2022: 66-71

Comparison of Analgesic Effects of Intravenous and Intraperitoneal Magnesium Sulphate in Laparoscopic Cholecystectomy: A Prospective Randomized Controlled Study

Background: Postsurgical pain following laparoscopic cholecystectomy is often associated with delayed recovery and discharge from the hospital. Magnesium sulphate as an adjuvant has shown a potential role as an anti-analgesic drug perioperatively. However, the data on the effectiveness and safety of magnesium sulphate delivered via two distinct routes (intravenous and intraperitoneal) for postoperative pain management is scant.&#x0D; Methods: This prospective randomized controlled trial was conducted on 80 adult patients. Group A (n=40) received 30ml intravenous magnesium sulphate(50mg/kg) and 30ml 0.25% bupivacaine intraperitoneal infiltration. Group B (n=40) received 30ml intraperitoneal infiltration of magnesium sulphate(50mg/kg) along with 0.25% bupivacaine and 30ml intravenous 0.9% normal saline infusion. Postoperative pain-free duration, pain scores (visual analog score), need of rescue analgesia, intraoperative hemodynamics and postoperative complications were noted.&#x0D; Results: The Visual analogue scores at 1,2,4 and 6 postoperative hours were 1.75±0.78, 1.33±0.66, 0.60±0.50, 0.45±0.55 in Group B and 2.13±0.61, 1.65±0.62, 1.28±0.88, 0.73±0.51 in Group A respectively (P-value-0.02,0.03,0.00 and 0.02). The time of the first request for rescue analgesia in Group A was 37.09± 5.54 and in Group B 52.00±4.30 (P value-0.00). Mean heart rate, systolic and diastolic blood pressure were significantly lower in Group A compared to Group B (P-value&lt;0.05). Extubation and emergence time was significantly higher in group A compared to Group B (P-value -0.00). The Abbreviated mental test (AMT)-4 cognition scores were similar in both groups while Alert, Voice, Pain and Unresponsive (AVPU) sedation score was higher at the first postoperative hour in Group A (1.30± 0.46) compared to Group B (1.10 ± 0.30) (P value- 0.026).&#x0D; Conclusion: Intraperitoneal magnesium is a safe and efficient means of controlling postoperative pain. Additionally, it decreases the time required for emergence and extubation as compared to intravenous delivery. Intravenous magnesium has better hemodynamic control in perioperative period.

A Comparative Study of Bilateral Erector Spinae Block Versus Intravenous Dexmedetomidine for Perioperative Pain Management in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting - A Single-Blind Randomized Controlled Trial

Regional analgesia, along with general anesthesia, reduce postoperative pain. In this study, the authors compared the erector spinae plane (ESP) block having dexmedetomidine as an adjuvant with conventional pain management along with intravenous dexmedetomidine. Prospective randomized single-blinded trial. Tertiary care teaching hospital. All of the patients scheduled for elective off-pump coronary artery bypass grafting with an ejection fraction of >45%. After obtaining institutional ethical committee approval, 130 patients were randomized into Group E and Group D. Group E patients received ESP block bilaterally with 25 mL of bupivacaine plus 0.5 μg/kg of dexmedetomidine. The patients in Group D received conventional intravenous analgesia, as well as a 0.7 μg/kg of dexmedetomidine bolus, followed by a 0.3 μg/kg dexmedetomidine infusion during surgery and continued postoperatively for 24 hours. Group E patients received 8 mL/h of bupivacaine infusion bilaterally for 24 hours. The primary outcome assessed was pain scores in the postoperative period. The secondary outcomes assessed were postoperative rescue analgesic consumption, time to first rescue analgesia, intraoperative fentanyl consumption, duration of mechanical ventilation, and duration of intensive care unit (ICU) stay. Both groups were comparable in demographic characteristics. The postoperative pain scores from 4 hours to 12 hours were lower in Group E compared with Group D. The pain scores at 24 hours were not significantly different between groups. Postoperative fentanyl consumption in Group E (99.23 ± 50.19 μg) was significantly lower than in Group D (181.15 ± 82.92 μg), with a p value of 0.001. Time to first rescue analgesia was significantly longer in Group E, with a median score of 8 hours when compared with that of 4 hours in Group D, with a p value of 0.01. Intraoperative fentanyl consumption was significantly lower in Group E (392.15 ± 55.36 μg) compared with Group D (604.00 ± 131.87 μg; p=0.001). There were no significant differences in the duration of mechanical ventilation in both groups. Duration of ICU stay was significantly lower in Group E (51.95 ± 8.54 hours) when compared with Group D (59.06 ± 8.68 hours) (p=0.001). Erector spinae fascial plane blocks appeared to reduce postoperative pain scores in off-pump coronary artery bypass graft patients. Furthermore, ESP block was beneficial in terms of less intraoperative and postoperative opioid consumption, longer time to first rescue analgesia, and shorter ICU stay.

The Use of Antibiotics for the Prevention of Surgical Site Infections in Two Government Hospitals in Taif, Saudi Arabia: A Retrospective Study.

BackgroundSurgical site infections (SSIs) are among the most common postoperative complications. To reduce the occurrence of surgical wound infections, suitable antimicrobials should be administered.Aim of the workThis study investigated the prophylactic use of antibiotics to prevent SSIs, in terms of agents and/or combination preferences, and the adherence of surgeons to both national and international guidelines of surgical antibiotic prophylaxis in Taif city government hospitals.MethodsThis is a retrospective study using a chart review of patients' medical records in two government hospitals in Taif city, Saudi Arabia, from July 2016 to July 2018. While maintaining the confidentiality of the patient’s data, it was collected and analyzed using the chi-squared and Fisher’s exact tests, and the difference between means was tested using the student’s t-test.ResultsProphylactic antibiotics were used in 157 patients who had surgery (Group 1) while 52 patients did not receive preoperative antibiotics (Group 2). The most commonly used prophylactic antibiotics were metronidazole, cefuroxime, cefazolin, and ceftriaxone. Other antimicrobials used included cefotaxime, amoxicillin/clavulanic acid, cephalexin, and amoxicillin. Surgical site infections developed in one patient of those who received antibiotics preoperatively and in three Group 2 patients. The mean hospital length of stay in Group 1 was 38.5±9.2 hours, and 57.3±12.1 hours in Group 2 patients. The types of antibiotics used were generally within the scope of national and international recommended guidelines.ConclusionThe use of preoperative prophylactic antibiotics significantly reduces the development of surgical site infections and the mean length of hospital stay. Various antimicrobial drugs that were used prophylactically in surgical practice are within the recommendations of both national and international guidelines.

Oxidative stress in dogs during mid-gestation abortion: Fetal and maternal antioxidant alterations with clinical and hematological features

The present study aimed to evaluate the GSH and MDA levels in dog’s serum and vital organs of aborted fetuses, after application of two abortifacient. Animals of group I (n = 6) were treated twice with subcutaneous injection of 10 mg/kg aglepristone and group II (n = 3) received prostaglandin F2α at a dose of 125 μg/kg every 12 hours until abortion process completed. Hematologic examinations and sedimentation rates were performed of bitches. The duration between first occurrence of vaginal discharge to first expulsion of fetuses ranged between 14-29 hours (mean: 22.6±5.5 h) and 24-33 hours in group I and II, respectively. Both treatments significantly increased the serum MDA levels (P&lt;0.01); however aglepristone increased the MDA levels throughout the study, prostaglandin enhanced plasma MDA levels only on day 1. GSH levels were significantly lower in aglepristone-treated bitches than prostaglandin-treated animals (P&lt;0.05). The treatments resulted similar MDA levels in liver and heart tissues (P&gt;0.05). GSH levels in kidney, muscle and heart tissues did not differ between groups (P&gt;0.05), aglepristone resulted reduced GSH levels in liver tissue (P&lt;0.05). High MDA levels could be evaluated as a useful marker for fetal suffering in pregnancy controls. The MDA and GSH levels, measured in vital organs of fetuses, could suggest possible toxic effects of abortifacients in newborns, as both medical agents are being used in parturition induction.