Hours In Group Research Articles

Assesment of Postoperative Analgesic Effects of Intramuscular Tramadol Administration and Intraperitoneal Bupivacaine following Laparoscopic Cholecystectomy

Background: For postoperative pain relief after laparoscopic surgeries, intramuscular or intravenous non-steroidal anti-inflammatory drugs and opioids, infiltration at the incision site with local anesthetics, intraperitoneal infiltration of local anesthetics with adjuvants, epidurals and nerve blocks were in use. The study was aimed to assess the efficacy of intramuscular Tramadol and intraperitoneal instillation of bupivacaine on postoperative analgesia, postoperative nausea, and vomiting following laparoscopic cholecystectomy.
 Methods: This study included 60 American Society of Anesthesiologists (ASA) I and ASA II patients of aged 18-60 years who were scheduled for laparoscopic cholecystectomy under general anesthesia. 60 patients were classified randomly into two groups equally: Group T received 100 Mg of intramuscular tramadol and Group B received intraperitoneal instillation of 30 ml of plain bupivacaine. Time duration, postoperative pain, haemodynamics, nausea, vomiting, and time taken to rescue analgesia were noted.
 Results: The time for onset of analgesia was 6.51 ± 2.41min in group T and 7.61 ± 2.19 min in group B (p=0.039). The duration of analgesia was 2.37 ± 0.67 hours in group T and 3.65 ± 0.79 hours in group B (p=0.002). VAS Score was significantly lower in Group T than Group B at 1hr, 2hr, 4hr and 6hr (p <0.05). Intraperitoneal bupivacaine showed a significant reduction in postoperative pain for the first 6 hours postoperatively (P<0.05), and time taken to rescue analgesia requirement was prolonged (P<0.05). The rescue analgesia consumption of Paracetamol was 1.5 grams in group-B and 2.5 grams in group T (P<0.05) in 24 hr post-surgery. Nausea and vomiting were observed in 2 cases, and shoulder pain in one case in group T.
 Conclusion: Bupivacaine is effective in reducing postoperative pain, and it prolongs the requirement time for rescue analgesia after LC surgery. It also required less consumption of rescue analgesic without fluctuations in hemodynamics

The impact of meteorological parameters on the number of applications to the emergency department with acute urticaria: A retrospective study.

The study aimed to investigate the relationship between the patients who applied to the emergency department with acute urticarial and meteorological factors and determine the associated weather conditions. The relationship between acute urticaria patients who applied to the emergency department of a training and research hospital in a city with high altitude and continental climate characteristics in the eastern part of Turkey between January 2019 and December 2019 and meteorological data was evaluated retrospectively. The necessary data for the weather were obtained from the data of the Erzurum Meteorology Directorate, and the patient data were obtained from the hospital information management system and patient files. The meteorological data of the patients at the date of admission and the characteristics of the patients at that date were compared. The study identified 691 patients who applied to the emergency department diagnosed with urticaria in 2019. According to the seasons, it was observed that the patients applied most frequently in the summer months [n = 239; 34.6%]. In the univariable regression model, which was created by taking the values of weather events as a reference on the days when the urticaria presentation was not observed (Group I), it was determined that every 1-hour increase in the sunshine hour increased the probability of urticaria by 7.4% (p = 0.018). When the meteorological parameters on the days without urticaria (Group I) and the days with urticaria presentation (Group II) were compared, the sunshine hours were 7.9 (4.0-10.6) hours in Group II and 6.65 (3.3-8.85) hours in Group I (p = 0.001). Regarding relative humidity, higher humidity rates were observed in Group I compared to Group II (p = 0.009). In terms of mean temperature, daily maximum, and minimum temperature, higher temperature rates were detected in Group II (p<0.001). A relationship was determined between urticaria attacks and relative humidity and daily maximum and minimum temperature in patients who applied to the emergency department with acute urticaria.

Appraisal of Restraint Positions for Rumen Skin Clamp Fixation, Stay Suture, and Mobile Small Ruminant Surgical Chute Rumenotomy Based on the Haematology of Kano-Brown Goats

Standing position in large ruminants and lateral recumbence in small ruminants have been the age-long standard restraint approaches when carrying out most surgical procedures, without recourse to the associated induced surgical stress. This study fabricated a mobile small ruminant surgical chute for standing restraint position and compares its associated haematological responses with those induced in lateral recumbence position during rumenotomy in Kano Brown goats (KBGs). Eighteen Kano-Brown goats of both sexes diagnosed of rumen foreign body impaction were allocated to groups A, B and D. Goats in groups A and B underwent rumen skin clamp fixation (RSCF) and stay suture rumenotomy (SSR) techniques respectively, while on lateral recumbency. Goats in group D underwent rumenotomy while on standing restraint in a fabricated mobile small ruminant surgical chute (MSRSC). The six other KBGs diagnosed to be free of the rumen foreign bodies did not undergo any rumenotomy and thus, served as control (Group C). Haematological parameters were assayed pre- and post-rumenotomy at 0, 5, 24, 48, 72 hours and weeks 1, 2 and 3. The mean total white blood cell counts were 11.17 ± 1.4 X 109/L, 9.63 ± 1.44 X 109/L, and 8.58 ± 0.96 X 109/L) for groups A, B, and D respectively, at 0-hour post-rumenotomy. Mean TWBC was lowest at 48 hours in group D, postrumenotomy even though the difference was not significant (P &gt; 0.05). In conclusion, lateral recumbency restraints for Rumen Skin Clamp Fixation and Stay Suture rumenotomy versus standing restraints for Mobile Small Ruminant Surgical Chute Rumenotomy did not significantly impact on Haematology in Kano Brown Goats. This could mean that the fabrication was a success and an alternative to performing surgeries in standing restraints beside the conventional lateral recumbency restraints in ruminants.

Comparison Of Inter-Appointment Pain Between Calcium Hydroxide Mixed With Normal Saline And Calcium Hydroxide Mixed With 2% Chlorhexidine During Root Canal Treatment

Introduction: Pain is one of the major and common symptoms a patient goes through during root canal treatment (RCT). Calcium hydroxide [Ca(OH)2] combined with normal saline (NS) is commonly used as an intracanal medicament against root canal pathogens, but combination of Ca (OH)2 with chlorhexidine (2% CHX) is not routinely used. Aim of this study is to compare the combination of Ca(OH)2 +NS and Ca(OH)2 +2% CHX to reduce the interappointment pain in RCT. Methods: A comparative, prospective, qualitative study was conducted in the Department of Conservative Dentistry and Endodontics, KIST Medical College and Teaching Hospital from September 2022 to March 2023. Total of 60 patients aged 16-70 years were included in the study. Group I received Ca(OH)2+NS and group II received Ca(OH)2 +2% CHX. Pain score was recorded using visual analogue scale (VAS) from baseline to 6,12,24 and 48 hours. Results: The mean pain score after 6 hours for Group I was 0.93(±0.83) and Group II was 1.43 (±0.63); P=0.011. The mean pain score after 12 hours for Group I was 0.40(±0.56) and Group II was 0.90(±0.66); P=0.003. 24 hours, mean pain score for Group I was 0.27(±0.45) and Group II was 0.60(±0.56); P=0.014. Patients reported reduction of pain after 24 hours, with Ca(OH)2 +NS (Group I) than Ca(OH)2 +2% CHX (Group II). Conclusion: The combination of Ca(OH)2 +NS was more effective in reducing interappointment pain than Ca(OH)2 +2%CHX.

Intensive topical steroidregimen for enhanced very early recovery after small incision lenticule extraction.

This study aims to investigate the topical steroid regimen after small incision lenticule extraction (SMILE) for its effect on very early restoration of visual quality. A total of 180 patients (360 eyes) who underwent SMILE were enrolled. These patients were randomly assigned to three groups, with 60 patients in each group. The only difference among these three groups was the administration of 0.1% fluorometholone (FML) eye drops within two hours after SMILE: no FML in group A, 0.1% FML once every hour in group B and 0.1% FML once every half hour in group C. The corrected distance visual acuity (CDVA), objective scattering index (OSI), modulation transfer function (MTF) cut-off, Strehl ratio (SR) and incidence of subjective symptoms were evaluated preoperatively, at 2, 4 and 24h and one week after SMILE. The CDVA, MTF cut-off and SR values were significantly higher in group C, when compared to the other two groups, at 2 and 4h after SMILE (p < 0.05). Furthermore, the OSI and incidence of subjective symptoms were significantly lower in group C, when compared to the other two groups, at 2 and 4h after SMILE (p < 0.05). However, no significant differences in CDVA, MTF cut-off, SR, OSI and the incidence of subjective symptoms were detected among the three groups at 24h and one week after SMILE (p > 0.05). The administration of 0.1% FML eye drops every half hour within two hours after SMILE accelerates the restoration of visual and optical quality, and reduces the incidence of subjective symptoms during the very early phase after surgery.

Efficacy of Oral Toradol (Ketorolac) Compared to Oral Tramadol as a Preemptive Analgesic in Impacted Third Molar Surgery.

To compare ketorolac with Tramadol as a preemptive analgesic in impacted third molar surgery in terms of mean pain score, mean time of first analgesic and mean total analgesic consumption postoperatively. Experimental study. Place and Duration of the Study: Department of Oral and Maxillofacial Surgery, Islamic International Dental Hospital, (IIDH) Riphah International University, Islamabad, from March 2018 to March 2020. Ninety-four patients, aged 18-45 years with impacted third molars were divided into two groups. Preoperatively oral tramadol 50 mg was given in group A and oral ketorolac 10 mg was given in group B. Pain score was measured 3 hours postoperatively, using the visual analogue scale (VAS), the time was noted for first analgesic consumption in hours and total consumption of analgesics. The mean postoperative pain was measured for both groups. Pain was significantly less in Group B. The mean pain score was 4.02+1.20 in group A and 3.42+1.08 in group B measured at 3 hours postoperatively (p=0.02). The mean time interval for 1st postoperative analgesic was 2.90+1.24 hours in group A and 3.61+1.02 in group B (p=0.007). The mean total analgesic consumption was 3.75+1.27 grams in Group A and 2.27+1.74 grams min Group B (p=0.006). Preemptive Ketorolac has a more prolonged analgesic effect as compared to tramadol. Preemptive analgesia, Tramadol, Ketorolac, Pain score, Third molar surgery.

Efficacy of GV-1 Aqua-acupuncture for Acute Diarrhea in Dogs: A Controlled, Randomized Clinical Study

The objective of this randomized controlled study was to determine whether integrating GV-1 aqua-acupuncture (aqua-AP) and conventional therapy can accelerate the resolution of acute diarrhea in dogs. A total of 39 client-owned dogs experiencing acute diarrhea of less than 5 days duration were enrolled and randomly assigned to Group A, conventionally treated control (no aqua-AP); Group B, conventionally treated control plus sham aqua-AP (subcutaneous injection of vitamin B12 at a non-acupuncture point); or Group C, conventionally treated plus aqua-AP at GV-1 (vitamin B12 injected at GV-1 acupuncture point). Conventional treatment, uniformly applied to all patients, consisted of a bland diet, metronidazole and probiotics. Each owner, blinded to the group assignment of their dog, reported the time duration from the start of the treatment to the first observed normal stool (denoted as Tns). Study results revealed a significant difference among the Tns values of the 3 study groups. The meanSD Tns in Group A was 68.059.5 hours and 59.541.6 hours in Group B. Group C was 22.628.6 hours, which was more than 50% shorter than each of the other 2 groups. Furthermore, the proportion of subjects in Group C, whose first stool after treatment initiation was normal, was significantly greater than the other groups (A: 7.7%; B: 7.7%, and C 46.2%; p = 0.029). These findings suggest that aqua-AP at GV-1 can be an effective integrated treatment with conventional therapy for resolving acute diarrhea in dogs. Further studies with a larger sample size, and comparisons with other conventional treatments are warranted.

Efficacy of Incisional Ropivacaine Infiltration by Presternal Multi-Orifice Catheter for Post-sternotomy Pain Relief in Pediatric Patients Undergoing Cardiac Surgery: A Prospective, Randomized, Controlled Study

To evaluate the efficacy of incisional ropivacaine infiltration by presternal multi-orifice catheter to manage poststernotomy pain in pediatric cardiac surgery. A prospective, randomized, and double-blind comparative study. At a single-institution tertiary referral cardiac center. The study comprised 200 children undergoing cardiac surgeries through a midline sternotomy. Children were allocated randomly to 1 of 3 groups. Group A (n=65) and group B (n=64) received 0.375% ropivacaine infusion and intermittent bolus, respectively, by presternal multi-orifice catheter, whereas Group C (n=64) did not receive any local anesthetic (LA) drug. Postoperatively, intravenous paracetamol was used for multimodal analgesia, and fentanyl was given as rescue analgesia, respectively. Pain was assessed by a Modified Objective Pain Score (MOPS) for 48 hours postextubation. Group B had significantly lower early MOPS at the first hour, but in the later period, the mean MOPS was lower in group A. The requirement of the first rescue analgesia was 3 ± 1.51, 6.1 ± 2.26, and 2.6 ± 0.87 hours for groups A (n=60), B (n=60), and C (n=60), respectively. The 48-hour fentanyl consumption was significantly lower (p < 0.001) in group A (0.5 ± 0.68 µg/kg) and group B (0.7 ± 0.86 µg/kg) than the control group (3.4 ± 0.68 µg/kg). The length of intensive care unit stay was lower (p < 0.001) in groups A and B than in group C; however, the length of hospital stay was comparable (p=0.07). LA bolus and infusion through presternal multi-orifice catheter provided effective analgesia postoperatively. However, the bolus was more efficacious in the early phase but equivalent in later periods. Therefore, bolus and LA infusion can be used for steady poststernotomy pain relief in children undergoing cardiac surgeries.

The effect of induced fetal demise on induction to expulsion interval during later medication abortion: A retrospective cohort

ObjectivesTo investigate the effect of induced fetal demise on the induction to expulsion interval during later trimester medication abortion. Study designThis retrospective cohort was conducted at St. Paul’s Hospital Millennium Medical College, Ethiopia. Later medication abortion cases that had induced fetal demise were compared to matching cases with no induced fetal demise. Data were collected by reviewing maternal charts and analyzed using SPSS version 23. Simple descriptive analysis, χ2 test, and multiple logistic regression analysis were used as appropriate. Odds ratio, 95% CI, and p-value<0.05 were used to present the significance of the findings. ResultsA total of 208 patient charts were analyzed. Seventy-nine patients were provided with intra-amniotic digoxin, 37 patients were provided with intracardiac lidocaine, and 92 had no induced demise. The mean induction to expulsion interval was 17.8 hours in the intra-amniotic digoxin group, which is not statistically different than 19.3 hours in the intracardiac lidocaine and 18.5 hours in the group without induced fetal demise (p-value = 0.61). Expulsion rate after 24 hours was not statistically different among the three groups (5.1% in the digoxin group vs 10.6% intracardiac lidocaine group vs 7.8% in the no induced fetal demise group, p-value = 0.82). Multivariate regression analysis demonstrated that inducing fetal demise was not associated with successful expulsion at<24 hours (adjusted odds ratio [AOR] = 0.19, 95% CI, 0.03–1.29 and AOR = 0.62, 95% CI, 0.11–3.48, for digoxin and lidocaine, respectively) from induction. ConclusionsIn this study, inducing fetal demise using digoxin or lidocaine prior to later medication abortion was not associated with a reduction in the induction to expulsion interval. ImplicationsDuring later medication abortion with mifepristone and misoprostol, inducing fetal demise may not be associated with a change in the length of the procedure. Induced fetal demise may be required for other reasons.

Comparison of Norepinephrine &amp; Terlipressin vs Norepinephrine Alone for Management for Septic Shock

Introduction: Sepsis is a clinical syndrome that has physiologic, biologic, and biochemical abnormalities caused by a dysregulated inflammatory response to infection. The present study aimed to estimate the dose of injection of norepinephrine in micrograms/ kg/min after 12 hours of starting the vasopressor infusion to keep an MAP of above 65 mm Hg. Materials &amp; Method: The study was done for the period of two years. Patients who were 18 years and above; who were diagnosed with septic shock during their ICU course and whose relatives gave informed written consent were included in the study. Result: Total of 12 patients were lost during the study period and so in total 100 patients were enrolled for the study. Both the groups were comparable with respect to the MAP (p = 0.655). The norepinephrine dose in group I vs group II at 12 hours was found to be 0.163 ± 0.089 vs 0.396 ± 0.18 μg/kg/min (p &lt;0.001). Reduction in blood lactate concentration in 12 hours was significantly higher in group I [1.479 ± 1.46] than group II [0.08 ± 1.50] mmol/L (p = 0.002). Increase in the urine output of the patients in 12 hours in Group I [0.72 ± 0.44] than group II [0.47 ± 0.460] mL/kg/hour (p = 0.001). Conclusion: A low-dose continuous infusion of terlipressin may have a significant role in ensuring better organ perfusion, preventing renal injury, and improving the SOFA score of the patients when used in adjunct to norepinephrine, early in the management of septic shock.

Comparison of Two Different Intervals of Misoprostol Administration in Second Trimester Abortions.

Comparison of two different intervals of misoprostol administration after mifepristone in second trimester abortions. This 12-month prospective study was conducted at a tertiary care facility. Only pregnancies with congenital deformity or sterilisation failure were included in the study's recruitment of 100 women who visited the hospital for a second trimester abortion between 12 and 20 weeks; cases with scarred uteri were omitted. In a systematic random selection of 50 women in each group, the administration of 200 mg of mifepristone orally was followed by two distinct intervals of intravaginal misoprostol administration at 24- and 48-hour intervals. After 24 hours, group A women received intravaginal 400 mcg misoprostol three hourly, up to a maximum of five doses, while group B received the same doses after 48 hours. Induction abortion interval noted on various parameters and paired t test and chi square test applied. The mean IAI following misoprostol administration was 8.14 2±.03 hours in group A and 7.71 ±2.56 hours in group B. This difference was statistically insignificant. Average misoprostol doses for group A were 1.68±0.71 and for the group, B were 1.68±0.84; both doses were found to be statistically insignificant when used to induce abortion. All women aborted successfully in each group. There was no significant difference in side effects in both groups. Based on the results it was observed that shorter interval between mifepristone and misoprostol i.e., 24 hours can be chosen to decrease the hospital stay as there was no significant difference was seen after intravaginal misoprostol in terms of induction abortion interval, number of doses and side effects.

Equal mixture of 2% lidocaine with adrenaline and 0.5% bupivacaine 20 mL provided faster onset of complete conduction blockade during ultrasound-guided supraclavicular brachial plexus block than 20 mL of 0.5% bupivacaine alone: a randomized double-blinded clinical trial

IntroductionRecent evidence has questioned the advantage of local anesthetic (LA) combinations. This study tested the hypothesis that mixing rapid-onset (lidocaine) and long-duration (bupivacaine) LA would provide faster onset of complete...

Regional Analgesia for Laparoscopic Cholecystectomy Using Ultrasound-guided Quadratus Lumborum Block or Erector Spinae Block: A Randomized Controlled Trial

BACKGROUND: Postoperative pain increases the incidence of venous thrombosis and respiratory complications, prevents early postoperative ambulation, and prolongs hospital stay. Fascial plane injections such as erector spinae plane (ESP) block and quadratus lumborum (QL) blocks are popular methods for postoperative pain control and reducing opioid consumption. OBJECTIVES: We aimed to evaluate the analgesic effects of ultrasound-guided ESP versus QL block during laparoscopic cholecystectomy for the reduction of pain and analgesic consumption. STUDY DESIGN: Prospective, double-blind, single-center, randomized controlled clinical trial. SETTING: Minia University Hospital, Minia Governorate, Egypt. METHODS: Patients scheduled for laparoscopic cholecystectomy from April 2019 through December 2019 were randomly allocated into 3 groups. After induction of general anesthesia, Group A received an ESP block, group B received a QL block, and group C didn’t receive any block (control). The main outcome was the time to the first analgesic request. Secondary outcomes were the pain intensity measured by the Visual Analog Scale at one, 2, 4, 6, 8, 12, 16, 20, and 24 hours postoperatively at rest and cough. The total analgesic requirement during the first 24 postoperative hours, hemodynamics, and any complications were recorded. RESULTS: Sixty patients scheduled for elective laparoscopic cholecystectomy were enrolled; the clinical and demographic data were similar in the 3 groups. Groups A and B had lower VAS scores at cough than Group C in the first postoperative 2 hours. Compared to Group C, a higher score was reported at 8, 12, and 16 hours in Group A, and at 8 and 16 hours in Group B. Group B had a higher score at 4 hours than Group A. At rest, Group C showed higher scores than Groups A and B in the first 2 hours, while higher scores were noted at 16 hours in Group A and 12 hours in Group B. Time to first request of analgesia was significantly prolonged in Group A than in Groups B and C (P &lt; 0.001). Our study showed that Groups A and B had lower postoperative analgesic requirements than Group C (P &lt; 0.05). LIMITATIONS: This study had a small number of patients enrolled. CONCLUSIONS: Both ESP and QL blocks effectively reduced VAS scores at both cough and rest. There was a decreased total consumption of analgesics in the first postoperative 24 hours with a longer duration of analgesia, which lasted 16 hours in the ESP group and 12 hours in the QL group. KEY WORDS: Plane nerve block, cholecystectomy, postoperative pain, regional analgesia

Comparison of post-operative complications, operative time and hospital stay between laparoscopic and open pyloromyotomy.

Objective: To compare operative time, hospital stay and post-operative complications between laparoscopic and open pyloromyotomy. Study Design: Randomized Prospective study. Setting: Department of Paediatric Surgery, Pak Emirates Military Hospital, Rawalpindi. Period: 7th May 2022 to 7th November 2022. Material &amp; Methods: This study included 20 patients each in the two groups. Group A underwent laparoscopic whereas group B underwent open pyloromyotomy. Both groups were compared regarding operative time (OT), hospital stay (HS) and post-operative complications. Results: OT ranged from 20 to 70 min with a mean of 15.4 min in group A. In group B, the mean OT was 25.6 min (range, 25–60 min). HS ranged from 14 to 58 hours with a mean of 16.8 hours in group A. In group B, it ranged from 19 to 30 hours, and the mean was 24.2 hours. One case in group A was converted to open approach (conversion rate 5%) because of mucosal perforation while one case of incomplete pyloromyotomy was found. Conclusion: Laparoscopic technique has shorter operative time and hospital stay than open surgery. Complication like mucosal perforation were seen in laparoscopy group, however, it was not found statistically significant.

Comparison of Lignocaine with Ondansetron for Attenuation of Propofol Induced Pain in Adult Patient Undergoing Laparoscopic Cholecystectomy: A Comparative Randomized Study.

Background: Propofol is a non-opioid intravenous anesthetic agent and it is most commonly used for induction of anesthesia but it has a consistent side-effect of pain when it is injected intravenously. Aim of our study was to compare lignocaine and ondansetron for attenuation of pain on propofol injection in laparoscopic cholecystectomy. Methods: 100 patients planned for laparoscopic cholecystectomy were enrolled for this comparative randomized study. Group L (Lignocaine) – Patients received Inj. Lignocaine 0.5 mg/kg 1 minute before inducing with injection propofol. Group O (Ondansetron) – Patients received Inj. Ondansetron 0.1mg/kg 1 minute before inducing with injection propofol. The patient was evaluated for pain during injection using a four-point scale of 5 seconds and 15 seconds after the propofol injection. Chi-squared test, Fisher’s exact test, and Mann-Whitney test were used for data analysis. Result: Demographic data in group L and group O were similar. The mean± SD pain score during the first 5 seconds in group O was 0.38 ± 0.57 while in group L was 0.02 ± 0.14 (p&lt;0.001). The mean± SD post-operative nausea and vomiting (PONV) score during the first hour in group O was 0.08 ± 0.27 while in group L was 1.96 ± 1.160 (p&lt;0.001). Conclusion: We concluded that lignocaine was found more effective than ondansetron for attenuation of propofol-induced pain and post-operative nausea vomiting was much lower than by ondansetron as compared to lignocaine.

The Effect of Easily Implementable Changes to the "D's of Stroke Care" in Reducing Sex Disparity in Door-to-Needle Time.

Door-to-needle (DTN) is the duration between patient's arrival at the hospital and receiving intravenous thrombolysis in ischemic stroke settings, for which studies have reported delays in women. The "D's of stroke care" describes 8 steps (D1 to D8) in patients' time tracker. We implemented simple modifications to the "D's of stroke care" by splitting D4 and D6 steps into these substeps: patients' arrival to the emergency room (D4-A), early assessment by a neurologist (D4-B), neurologist decision on patient's eligibility to receive recombinant tissue plasminogen activator (D6-A), and patient's transfer to the stroke unit (D6-B). We evaluated the effect of these changes on reducing DTN time disparity between men and women. This study was conducted from September 2019 to August 2021, at a comprehensive stroke center. Patients were analyzed in 2 groups: group 1, before, and group 2, after using the modifications. Sex as the main variable of interest along with other covariates was regressed toward the DTN time. In groups 1 and 2, 47 and 56 patients received intravenous thrombolysis, respectively. Although there was a significant difference in DTN≤1 hour between women and men in group 1 (36% vs. 52%, P=0.019), it was not significantly different in group 2 (P=0.97). Regression analysis showed being female was a significant predictor of DTN>1 hour in group 1 (adjusted odds ratio=6.65, P=0.02), whereas after using the modifications, sex was not a significant predictor for delayed DTN. Implementing these substeps reduced sex disparity in DTN time in our center.

A PROSPECTIVE STUDY OF POST MASTECTOMY SKIN FLAP ANCHORING AND SEROMA MONITORING

Background: Breast cancer is the leading cancer which aficts females globally. In order to decrease the incidence of post-operative complications, skin ap anchoring has been proposed by different authorities. The present study was conducted to assess and compare the outcomes of skin ap anchoring with standard wound closure techniques in the reduction of seroma formation in cases operated for invasive breast cancer. Materials &amp; Methods: This prospective observational study (duration: from Feb 2021 to July 2022) conducted on 50 invasive breast cancer patients in the department of surgery in our institute. Informed consent was taken and then, patients were divided in two groups of 25 patients each. Group Aunderwent MRM with skin apanchoringand group Bunderwent MRM with standard closure ofthe skin apsat the surgical wound edges. The patients were followed up for post-operative complications. The results were then analyzed.Results: In the present study, the mean age of patients in group A and group B were 53.24 ± 7.45 years and 52.04 ± 6.83 years, respectively (non-signicant; p-value 0.556). The mean drain volume in group A and group B were 61.96±16.38 mL and 83.17±15.67 mL, respectively. (Signicant; p-value &lt;0.001). The mean duration of surgery was 2.06 ± 0.17 hours in group A, while in the group B, it was 2.18 ± 0.32 hours (non-signicant; p-value 0.104). The mean duration of use of tube drainage was 4.24 ± 0.44 days in groupA, while in the group B, it was 6.4 ± 1.08 days (Signicant; p-value &lt;0.001). In group A, the mean length of hospital stay was 4.24 ± 0.44days, while in thegroupB, it was 6.4 ± 1.08days (Signicant;p-value &lt;0.001).IngroupA, the mean seromaaspiration volume was 1.4 ± 3.96 mL, while in the group B, it was 3.4 ± 5.72 mL (non-signicant; p-value 0.158). Surgical site infection was present in 4%patientsofgroup A, and 8% patients of group B ( non-signicant;p value 0.552). Flapnecrosis was presentin 4 %patients in both the groups (non-signicant; p-value 1.00). Conclusion: While modied radical mastectomy with skin ap anchoring was found to better while considering drain volume, duration of use of tube drainage, and length of hospital stay. The modied radical mastectomy with skin ap anchoring was comparable to MRM with standard closure of the skin aps in terms of duration of surgery, seromaaspirationvolume, andpost-operativecomplications (surgical siteinfectionandapnecrosis)

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.&#x0D; 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.&#x0D; 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).&#x0D; 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.&#x0D; 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.&#x0D; 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).&#x0D; 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.