Paracetamol Infusion Research Articles

Efficacy of Intravenous Tramadol vs Paracetamol Infusion for Postoperative Pain in Patients Undergoing Laparoscopic Surgery: A Single - Blinded Randomised Comparative Study

Efficacy of Intravenous Tramadol vs Paracetamol Infusion for Postoperative Pain in Patients Undergoing Laparoscopic Surgery: A Single - Blinded Randomised Comparative Study

Simple febrile seizure et causa bronchopneumonia with complex congenital heart disease.

Complex congenital heart disease (CHD) in children does not often cause febrile seizures. A child with simple febrile seizures, bronchopneumonia, and complex congenital heart disease is discussed. The report analyzes the causes and proposes preventive measures for febrile seizures, bronchopneumonia, or both. A 2-year-old girl with complex congenital heart disease presented with simple febrile seizures possibly caused by bronchopneumonia. The child was severely malnourished (<-3SD), with a body weight of 7.5kg and a height of 78cm. Diagnostics revealed leukocytosis and neutropenia, with X-ray results showing abnormalities in the lungs and heart (ASD, VSD, and PDA). Treatment included diazepam 5 mg rectally for the first seizure and 1 mg IV for the second seizure, as well as paracetamol infusion 5 ml/4h. Understanding simple febrile seizures triggered by bronchopneumonia in patients with complex congenital heart disease requires an integrated approach for patient management, including comprehensive care. The involvement of medical personnel is an important challenge in preventing recurrence and ensuring optimal patient outcome. Simple febrile seizures are likely caused by bronchopneumonia accompanied by complex congenital heart disease. Her recovery after prompt treatment with diazepam and symptomatic drugs emphasizes the importance of recognizing seizure triggers and managing febrile seizures in children with cardiac anomalies.

Efficacy of Multimodal Analgesia with Transversus Abdominis Plane Block in Comparison with Intrathecal Morphine and Intravenous Patient-Controlled Analgesia after Robot-Assisted Laparoscopic Partial Nephrectomy.

Background: Robot-assisted laparoscopic partial nephrectomy (RAPN) for renal tumor treatment provides ergonomic advantages to surgeons and improves surgical outcomes. However, moderate-to-severe pain is unavoidable even after minimally invasive surgery. Despite the growing interest in multimodal analgesia, few studies have directly compared its efficacy with intrathecal morphine, a traditional opioid-based analgesic. Methods: We retrospectively investigated the efficacy of multimodal analgesia compared with that of intrathecal analgesia and intravenous patient-controlled analgesia (IV-PCA) in patients who underwent transperitoneal RAPN at our institute between 2020 and 2022. Among the 334 patients who met the inclusion criteria, intrathecal analgesia using morphine 200 µg was performed in 131 patients, and multimodal analgesia, including transversus abdominis plane block and intraoperative infusion of paracetamol 1 g and nefopam 20 mg, was administered to 105 patients. The remaining 98 patients received postoperative IV-PCA alone. Results: As the primary outcome, the area under the curve of pain scores over 24 h was significantly lower in the intrathecal analgesia and multimodal analgesia groups than in the IV-PCA group (89 [62-108] vs. 86 [65-115] vs. 108 [87-126] h, p < 0.001). Cumulative opioid requirements were also significantly lower in the intrathecal analgesia and multimodal analgesia groups at 24 h after surgery (p < 0.001). However, postoperative nausea and vomiting were significantly increased in the intrathecal analgesia group (27.5% vs. 13.3% vs. 13.3%, p = 0.005). Conclusions: Multimodal analgesia with a transversus abdominis plane block is an efficient analgesic method with fewer adverse effects compared to other analgesic methods. Our findings suggest the efficacy and safety of a multimodal approach for opioid-sparing analgesia after RAPN in the current opioid epidemic.

Efficacy of intravenous infusion of paracetamol as an intrapartum labour analgesia

Efficacy of intravenous infusion of paracetamol as an intrapartum labour analgesia

Comparison of The Level of Satisfaction With The Use of Analgesics Ketorolac 30 Mg and Paracetamol 1000 Mg in Moderate Post-Operative Patients

&lt;table cellspacing="0" cellpadding="0" align="left"&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left" valign="top"&gt;&lt;p&gt;&lt;em&gt;Pain is an uncomfortable feeling that can be an emotional experience and has the potential to cause real tissue damage. Post-operative events can cause patients to feel pain in certain parts of the body. In post-operative care to reduce pain, patients are given NSAID (Non-Steroid Anti-Inflammatory Drugs) analgesic drugs, and the drugs commonly used are Ketorolac 30mg and Paracetamol 1000mg. The use of analgesics is said to be effective if the patient's perception shows satisfaction after using the analgesic. The research was conducted to see the level of patient satisfaction in using the analgesic intravenous injection of ketorolac 30mg and intravenous infusion of paracetamol 1000mg. This research used a Randomized Controlled Trial (RCT) design with double blinds. Data collection was carried out in April–July 2021 at PKU Muhammadiyah Gamping Hospital. Then the data obtained was analyzed using the Chi-Square test. There were 40 respondents who met the inclusion and exclusion criteria. The analysis results show a significance value of 0.006&amp;lt;0.05. Thus it can be concluded that there is a difference in satisfaction with the use of analgesics. The research showed that the level of satisfaction with the use of the analgesic intravenous injection Ketorolac 30mg in mild to moderate post-operative patients at PKU Muhammadiyah Gamping Hospital was higher than the use of intravenous infusion Paracetamol 1000mg. &lt;/em&gt;&lt;em&gt;We suggest conducting additional research with a&lt;/em&gt;&lt;em&gt; larger and more diverse sample to yield results applicable to a broader population.&lt;/em&gt;&lt;em&gt; &lt;/em&gt;&lt;em&gt; &lt;/em&gt;&lt;em&gt;We also &lt;/em&gt;&lt;em&gt;recommend the routine use of 30mg ketorolac injection.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Keywords : Anti-pain, postperative, satisfaction level&lt;/em&gt;&lt;/strong&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt;

Studi Kasus Pasien Dengan Meningitis Tuberkulosis Dalam Pengobatan Tuberkulosis Paru

TB meningitis is the most severe manifestation of tuberculosis infection and causes death and disability in 50% of sufferers. Tuberculosis primarily affects adults at their most productive ages. However, all age groups remain at risk. Tuberculous meningitis is a form of extra-pulmonary tuberculosis with neurological abnormalities that accounts for 70-80% of all neurological tuberculosis cases, 5.2% of all extrapulmonary tuberculosis and 0.7% of all tuberculosis cases. Tuberculous meningitis (TB) is preceded by prodromal symptoms such as headache, anorexia, nausea/vomiting, subfebrile fever, accompanied by behavioural changes, and decreased consciousness. The patient, a 42-year-old male Mr SM, presented with decreased consciousness, a history of seizures and was taking tuberculosis drugs. Meningeal stimulation was found to be rigid, laseque test and kernique test were positive. Motor system impression of lateralisation to the right. Laboratory examination showed leukocytes 13,500/uL, platelets 728,000/uL, sodium 123 mmol, Kgd 135, thoracic X-ray with the impression of pulmonary tuberculosis with pneumonia, cranial CT-scan obtained with the impression of appropriate Tb meningitis, Non Communicating hydrocephalus. Specific treatments given were IVFD NaCL 0.9 % 20 drops / m, Omeprazole vial 2x40 mg, paracetamol infusion 3x1000 mg, Ceftriaxone 1 gram Vial, dexamethason ampoule loading 2 ampoules then 3x5 mg, Phenytoin 3x100 mg, Levofloxacin 750 mg, rifampicin 1x450 mg, isoniazid 1x300 mg, pyrazinamide 1x1000 mg, ethambutol 1x1000 mg, mg, B6 and B12 2x1 tablets.

Kawasaki disease in an infant: a case report

Background: Kawasaki disease is an acute systemic vasculitis of childhood, with a predilection of the main coronary artery. This disease is the most frequent cause of acquired heart disease in developed countries. This report is aimed to describe the diagnosis and treatment of Kawasaki disease in an infant. Case description: A 4-month-old boy came to the emergency room on November 21, 2021, with a chief complaint of high fever for three days. His appetite has decreased since he got sick. Other complaints, such as red eyes, red lips and red rashes overall his body, occurred two days before the admission. Physical examination: the child's nutritional status was good, with bilateral non-purulent conjunctivitis, erythema and cracked lips, and polymorphous rash on the body, back, and legs. We found enlarged cervical lymph nodes and reactivation of Bacillus Calmette-Guerin (BCG) scars. The laboratory findings were as follows: HGB 10.6gr/dL, WBC 11.570/µL, PLT 335.000/µL, CRP 84mg/dL, Antigen NS-1 dengue test negative, and SARS-COV2 Antigen test negative. The echocardiography results were minimal pericardial effusion and normal coronary size. With a Harada score of 4, he was diagnosed with Kawasaki disease. Management of the patient includes breastfeeding, infusion of dextrose 5% with sodium chloride (Na Cl) 0.22%, Paracetamol infusion, Intravenous Immunoglobulin (IVIg) single dose, and Acetylsalicylic acid orally. After being discharged from the hospital, he was advised to control his condition routinely to a pediatrician. Conclusion: Kawasaki disease has been reported in a 4-month-old boy with typical clinical manifestations and successfully treated with good results.

Challenges in Assessing Blood Pressure in Adults Following Intravenous Paracetamol Infusion in the Emergency Room.

Background and objective The negligible side effects of paracetamol along with its ease of availability have catapulted paracetamol to be a widely used medication in emergency room management to reduce pain and subsequent elevations in blood pressure (BP). Our study aimed to address thechallenges in informed clinical decision-making in the emergency room following paracetamol intravenous infusion. Methods This was a retrospective cross-sectional studyinvolving the extraction of data from electronic medical records of patients who received intravenous paracetamol infusion between January 2022 and May 2022. Demographic information and BP-related data were collected for analysis. Results We initially considered a total of 162 patient records, with 132 of them eventually meeting the inclusion criteria. Among patients receiving paracetamol infusion for 15 minutes or less, 34% showed a drop of 1-5 mmHg in systolic BP (SBP), while 26% experienced a drop of 6-10 mmHg. However, infusion time longer than 16 minutes did not significantly reduce SBP. Diastolic BP (DBP) was not significantly affected by theduration of the paracetamol infusion.Analysis of the drop in SBP revealed no significant associations with age, gender, or ethnicity. Mean arterial pressure (MAP) was not significantly affected by theduration of paracetamol infusion. Conclusion Our findings suggest that intravenous paracetamol infusion does not significantly lower BP in adults in the emergency room, except for infusions ofshorter durations. However, various factors, including infusion rate, patient characteristics, and concomitant medications, may influence BP measurements. The study emphasizes the need for establishing standardized criteria and conducting further research to assess intravenous paracetamol's hemodynamic effects accurately.

Evaluation of USG-guided novel sacral erector spinae block for postoperative analgesia in pediatric patients undergoing hypospadias repair: A randomized controlled trial.

Erector spinae plane block (ESPB) has been found to be simple, safe, and effective at thoracic and lumbar levels. There is no randomized controlled trial evaluating its effectiveness at sacral level. The present study was conducted to evaluate its effectiveness at sacral level for postoperative analgesia in pediatric patients undergoing hypospadias repair. Forty children of 2-7 years with ASA grade I or II were included. They were randomly allocated to one of the two groups of 20 patients each. After induction of general anesthesia, patients of group I were given ultrasound-guided sacral ESPB with 1 ml/kg of 0.25% bupivacaine, and patients of group II were not given block. Postoperatively, pain was assessed using face, legs, activity, cry, consolability (FLACC) scale at 0 hour, every 15 min up to 1 hour, every half an hour up to 2 hours, 2 hourly up to 12 hours, and at 18th hour and 24th hour postoperatively. At FLACC score ≥4, rescue analgesia was given using 15 mg/kg paracetamol infusion. Primary objective was to compare postoperative analgesic (paracetamol) consumption, and secondary objective was time to first rescue analgesia. Mean postoperative paracetamol consumption was 360 ± 156.60 mg in group I and 997.50 ± 310.87 mg in group II (P = 0.001). Time to first rescue analgesia was 906 ± 224.51 min in group I and 205.00 ± 254.92 min in group II (P = 0.001). Sacral ESPB has been found to be effective in reducing postoperative analgesic consumption in pediatric patients undergoing hypospadias repair.

Transverse abdominis plane block as a method of anesthesia after caesarean section

Although we have various methods of analgesia, the prevalence of severe pain after caesarean section remains high. Therefore, it is necessary to look for new reliable technologies for optimal postoperative anesthesia.The objective was to compare the efficiency of postoperative wound infiltration with a local anesthetic and transverse abdominis plane block (TAP-block) as a component of multimodal analgesia in the postoperative period after cesarean section.Materials and methods. A prospective randomized study was conducted. It included 91 patients after elective caesarean section under spinal anesthesia. Patients were divided into 3 groups depending on the method of postoperative analgesia. In group 1 (n = 30), we used wound analgesia. In group 2 (n = 32), transverse abdominis plane block was performed. In group 3 (n = 29), intravenous infusion of paracetamol in combination with intramuscular injection of tramadol 0.5 mg/kg were used for postoperative analgesia.Results. Pain syndrome was less severe after wound analgesia and TAP-block for 24 hours compared to analgesia with systemic analgesics. Moreover, during wound analgesia, lower points of the visual analogue scale (VAS) were traced for three days. The minimum consumption of paracetamol was on the background of wound analgesia, while no patient required the introduction of narcotic analgesics. Women in the wound analgesia group were able to earlier activating: they could walk after 5.6±0.2 hours, compared to 6.1± 0.2 hours with TAP-block and 8.8± 0.4 hours with analgesia with systemic analgesics.Conclusion. Continuous analgesia of postoperative wound is a safe and effective method that allows achieving adequate postoperative analgesia, avoiding using narcotic analgesics and reducing the consumption of non-narcotic systemic analgesics.

A comparative study of the efficacy of intravenous paracetamol and dexmedetomidine alone and in combination on perioperative hemodynamics and post-operative analgesia for patients undergoing laparoscopic cholecystectomy under general anesthesia

Background: With increase in incidence of gallbladder stone disease, the laparoscopic cholecystectomy is most preferred surgical technique. Laryngoscopy and peritoneal gas insufflation leads to hemodynamic stress response and pain during and after the procedure. Multimodal analgesia is recommended to reduce the stress response and prevent the post laparoscopic pain. Intravenous paracetamol and intravenous dexmedetomidine are both effective components in respect of multimodal analgesia. Aims and Objectives: The aim of this study was to compare and evaluate the effects of intravenous paracetamol and dexmedetomidine alone and in combination as part of multimodal analgesia on perioperative hemodynamics and post-operative analgesia. Materials and Methods: One hundred and five patients between the of age 18–60 years posted for laparoscopic cholecystectomy were randomly assigned to three groups (n=35). Before induction patients in Group D received dexmedetomidine 0.5 μg/kg/h and patients in Group P and Group P+D received 1 g paracetamol infusion over 15 min. Intraoperatively as continuous infusion patients in Group D and Group P+D received dexmedetomidine 0.2 μg/kg/h and Group P received 0.2 mL/kg NS until the removal of gallbladder. Perioperative hemodynamic variables, postoperatively, the need for rescue analgesia and any complications or side effects were recorded, compared, and analyzed. Results: Intraoperative hemodynamic variables were significantly higher in Group P compared to Group D and Group P+D (P&lt;0.05). Prolonged rescue analgesia found in Group P+D (9.06±1.16 h) then Group D (5.52±1.22 h) and Group P (4.35±0.99 h), respectively, which was strongly significant among the groups (P&lt;0.0001). Conclusion: Our study concluded that the combination of paracetamol and dexmedetomidine maintains the better hemodynamic stability and prolonged the duration of analgesia, with the benefit of high patient satisfaction. In addition, there was significantly less post-operative bradycardia and shivering.

Dolor local durante la administración de paracetamol endovenoso que tiene como excipiente ácido acético

Objective: to evaluate the presence of local pain during the intravenous administration of paracetamol with acetic acid compared with the administration of paracetamol without acetic acid in patients undergoing a procedure in the surgical unit. Methods: a double-blind randomized controlled clinical trial was conducted on two groups. All patients of age who underwent a procedure in the surgical unit of the Fundació Salut Empordà (Girona, Spain) from August to November 2020 and who needed the administration of intravenous paracetamol were included in the study. Sixty (60) patients were required per group (paracetamol with acetate vs. paracetamol without acetate). Sociodemographic variables were collected, as well as those related to the venous catheter, treatment, presence and time of pain, pain assessment according to the verbal numerical scale (from 0=no pain to 10=the worst pain imaginable). Descriptive and bivariate analysis. Comparison between arms according to the assigned protocol. Results: sixty (60) patients were included in each arm. Their mean age was 56.6 years (SD =15.6), and 56.7% were male. Arms were homogeneous and comparable at baseline. The presence of pain was detected in 48.3% (n= 29) of patients in the group receiving infusion of paracetamol with acetic acid, while there were no cases of pain in the group without acetate (p< 0.001). Conclusions: statistically significant differences were observed between the group of patients undergoing procedures in the surgical unit who were administered paracetamol without acetic acid, who did not present pain, vs. the group receiving paracetamol with acetic acid, where pain was present in almost half of the patients.

The Effect of Analgesia with Ketamine, Morphine and Paracetamol for Burn Pain in North-Eastern Iran

Background: Pain is a common and challenging problem in burn patients. The severity of pain in these patients often requires multi drug therapy. On the other hand, with increasing the number and dosage of drugs, the complications increase, so finding an instruction that provides acceptable analgesia with minimal complications is necessary.&#x0D; Methods: Based on the dose and half-life, the initial dose for paracetamol was 15 mg/kg every 6 hours, this dose was reduced to 30% after three days of initiation of the treatment to prevent liver toxicity and was discontinued after one week. Morphine started with an initial dose of 0.01 mg/kg/h and for opioid-tolerant patients, the initial dose was 0.02 mg/kg/h. Morphine infusion dose raised by 30 percent every week. The continuous intravenous infusion of ketamine (0.15 mg/kg/hr) with continuous intravenous infusion of morphine was administered by a silicone pump.&#x0D; Results: The mean NRS was significantly reduced in the first visit after the intervention (three hours later) (8.5 ± 1.04 vs.3.9 ± 1.74; p &lt;0.001) and this decrease was observed in NRS in continuous observations (P&gt; 0.001). Pain reduction was independent of history of opioids use.&#x0D; Conclusion: Continuous infusion of ketamine, morphine and paracetamol showed an effective pain management program for burn patients.

A COMPARATIVE STUDY OF INJECTION DICLOFENAC SODIUM VERSUS INJECTION PARACETAMOL INFUSION AS POST-OPERATIVE ANALGESIA IN LAPAROSCOPIC ABDOMINAL SURGERIES UNDER GENERAL ANAESTHESIA

Post operative pain is acommon symptom causing post-operative psychological stress and anxiety leading to physiological effects. This research paper compares the analgesic effect of IV Diclofenac Sodium versus IV Paracetamol infusion in post operative period following laparoscopic abdominal surgeries. Patients are divided into 2 groups and observations are made with regards to the duration of analgesia and drug related post opertaive complications in both these groups.

Effect of single dose preemptive intravenous paracetamol, dexamethasone, and magnesium sulfate on perioperative hemodynamic variables and post-operative nausea, vomiting, and pain in open cholecystectomy done under general anesthesia: A prospective, randomized, and single-blind study

Background: Pain due to open cholecystectomy can result in delayed recovery and poor operative outcomes. Multimodal approaches to pain control cause functional improvement. We compared the efficacy of paracetamol 1 g, dexamethasone 8 mg, and magnesium sulfate 2 g with normal saline in control over perioperative hemodynamics and post-operative pain in patients undergoing open cholecystectomy under general anesthesia. Aims and Objectives: This study conducted to assess the effect of preemptive intravenous paracetamol, dexamethasone, and magnesium sulfate on perioperative hemodynamic variables (primary outcome) and post-operative nausea, vomiting, and pain (secondary outcome) in open cholecystectomy. Materials and Methods: Sixty patients of ASA Grade I/II were randomized into two groups to receive either normal saline 100 ml iv (Group C, n=30) or infusion containing inj. paracetamol 1 g, inj. dexamethasone 8 mg and inj. magnesium sulfate 2 g iv (group PDM, n=30), 20 min before induction. Intraoperative and post-operative hemodynamic data, post-operative pain scores, and incidence of nausea vomiting were recorded. Results: Intraoperative pulse rate was significantly higher at intubation and 15 min after intubation in the control group and intraoperative systolic, diastolic, and mean arterial blood pressure were significantly higher in control group at intubation and until 60 min. Post-operative pulse rate was significantly higher in the control groups at 180 min and incidence of PONV reduced in PDM group until 90 min. Conclusion: Preemptive intravenous infusion of paracetamol, dexamethasone, and magnesium sulfate provided better stability over perioperative hemodynamics, reduced the incidence of post-operative nausea vomiting, and provided better post-operative pain control.

Adequacy of Anaesthesia for Nociception Detection during Vitreoretinal Surgery.

Vitreoretinal surgery (VRS) is one of the most widely performed precise procedures in ophthalmic surgery; the majority of cases are carried out under regional anaesthesia (RA) only. However, in specific situations (such as when the patient fails to cooperate with the operator for various reasons), general anaesthesia (GA), alone or in combination with GA (combined general-regional anaesthesia, CGR), is the only safe way to perform VRS. While monitoring the efficacy of an intraoperative rescue opioid analgesia (IROA) during surgery (assessing the adequacy of anaesthesia (AoA)) may be challenging, the surgical pleth index (SPI) is a useful tool for detecting the reaction to noxious stimuli and allows for the rational titration of opioid analgesics (AO) during surgery. The current study investigated the influence of the SPI-based titration of fentanyl (FNT) in combination with various pre-emptive analgesia (PA) techniques on intraoperative pain perception during various stages of VRS performed under AoA. A total of 176 patients undergoing VRS under GA were enrolled in the study. They were randomly assigned to one of the five following study arms: Group GA (control group)-patients who received general anaesthesia alone; Group PBB-GA with preprocedural peribulbar block (with 0.5% bupivacaine and 2% lidocaine); Group T-GA with preventive, topical 2% proparacaine; Group M-GA with a preprocedural intravenous infusion of 1.0 g of metamizole; and Group P-GA with a preprocedural intravenous infusion of 1.0 g of paracetamol. The whole procedure was divided in four stages: Stage 1 and 2-preoperative assessment, PA administration, and the induction of GA; Stage 3-intraoperative observation; Stage 4-postoperative observation. the SPI values were monitored during all stages. The occurrence of nociception (expressed as ∆SPI >15) during various manipulations in the surgical field was observed, as were cumulative doses of rescue analgesia, depending on the PA administered. During the course of VRS, rescue FNT doses varied depending on the stage of surgery and the group investigated. The majority of patients, regardless of their group allocation, needed complementary analgesia during trocar insertion, with Group GA patients requiring the highest doses. Likewise, the highest cumulative doses of IROA were noted during endophotocoagulation in Group GA. Preventive PBB and topical anaesthesia were proven to be most efficient in blunting the response to speculum installation, while topical anaesthesia and paracetamol infusion were shown to be more efficient analgesics during endophotocoagulation than other types used PA. In the performed study, none of the PA techniques used were superior to GA with FNT dosing under the SPI with respect to providing efficient analgesia throughout the whole surgery; there was a necessity to administer a rescue OA dose in both the control and investigated groups.

Comparative Evaluation of Different Parenteral Agents as Postoperative Analgesics among Patients of Lichtenstein Repair: A Prospective Observational Study

Introduction: Hernia surgery is one of the most frequently done surgeries worldwide. It is of special concern since, the postoperative pain can be because of injury to the nerves apart from the skin incision. Different drugs are used as analgesics for the management of postoperative pain, but there are hardly any guidelines for their judicious use. Besides, these analgesics are not free from clinically significant adverse effects. Therefore, there is a need of developing some guideline/protocols for using analgesics postoperatively. Aim: To compare the efficacy and safety of intravenous (i.v.) diclofenac bolus, i.v. paracetamol infusion, and i.v. tramadol as postoperative analgesics in cases of inguinal hernia undergoing Lichenstein repair (open hernioplasty). Materials and Methods: A prospective observational study was conducted in the Department of General Surgery at a Tertiary Care Teaching and Training Institute, North India. The duration of the study was two months, from February 2021 to March 2021. A total of 57 patients were included in the study and grouped as per the primary analgesic used in them, out of which 18 belonged to group A (i.v. diclofenac bolus), 22 to group B (i.v. paracetamol infusion), and 17 to group C (i.v. tramadol). Visual Analogue Scale (VAS) scores were assessed at 6 hours, 24 hours, and 48 hours, postoperatively. The type and frequency of additional analgesics used were noted. Any clinically significant adverse effects were also recorded. Analysis of Variance (ANOVA) and Chi-square tests were applied to analyse the continuous and categorical data respectively. Results: The mean age of the study participants was 48±16 years. The mean VAS scores at 6 hours were 3.6, 3.4, and 4.1 in the three groups, respectively. Whereas, at 24 hours and 48 hours, the scores were 3.5, 3.4, 3.4, and 2, 1.6, and 1.9, respectively. There was no statistically significant difference in the VAS scores. A total of 12 (66.67%) patients in group A, 18 (81.81%) in group B, and 16 (94.12%) in group C required additional analgesics but the difference was not statistically significant. Similarly, 5 (27.78%) patients in group A, 6 (27.27%) in group B, and 4 (23.53%) in group C suffered from adverse effects, but there was no statistically significant difference amongst them. Conclusion: Intravenous diclofenac bolus, i.v. paracetamol infusion, and i.v. tramadol are equally efficacious and safe, when used as postoperative analgesics in cases of inguinal hernia undergoing Lichtenstein repair. But studies with larger sample size are required to draw any definite conclusion.

Application of Six Sigma and KAIZEN Techniques to Non-Conformities:A Case Study of Pharmaceutical Companies

Every company certainly wants a good product and lots of it in order to get a profit, where at this time the competition is very tight. Therefore, this research is motivated by the many reject problems in the primary packaging product process (filling). This research was carried out at a pharmaceutical company located in Bogor, Wanaherang by taking problems with infusion bottles in January -March 2022, researchers also used 3 comparisons of infusion bottle products in companies, includes: levofloxacin, metronidaol, paracetamol infusion where the number of rejects in January and the most rejects in paracetamol infusion products are 2,303 pcs for 3 months, therefore this study aims to reduce the existing rejects by using the DMAIC, KAIZEN, Six sigma, FMEA and 7tools methodswith the results of the study finding 3 critical to quality that covers: fiber, dirt, packaging. The researcher proposes to improve human resources using the KAIZEN 5Smethodand also scheduling operator training and machine maintenance checks every month so that during the production process minimize all obstacles.

Effect of pre-emptive intravenous paracetamol, magnesium sulfate, and lignocaine on hemodynamic variables during perioperative period in pre-eclampsia patients scheduled for lower segment cesarean section under general anesthesia: A prospective randomized study

Background: Hemodynamic alterations during general anesthesia with endotracheal intubation are due to stimulation of the sympathetic nervous system and catecholamine release. Therefore, it is important to attenuate these responses in pre-eclampsia patients who are already under stress. Aims and Objectives: The present study aimed to evaluate the combined efficacy of paracetamol, magnesium sulfate, and lignocaine in attenuating hemodynamic responses during intubation and perioperative period. Materials and Methods: Eighty ASA II pre-eclampsia patients were randomly divided into two groups. Group PLM received intravenous infusion of paracetamol (1 g) and magnesium sulfate (30 mg/kg) in 100 ml normal saline and IV bolus Inj. lignocaine (1.5 mg/kg) 15 min before induction. Group C received only IV infusion of 100 ml normal saline. Pulse rate (PR), blood pressure (BP), and oxygen saturation were measured at various time intervals up to 40 min of delivery of baby and in up to 240 min in post-operative period. Post-operative visual analog score (VAS) and the time for first rescue analgesia (TRA I) were recorded. Results: Demographic and baseline hemodynamic parameters were comparable in both groups (P&gt;0.05). Changes in PR and BP during laryngoscopy, intubation, and perioperative period were significantly lesser in Group PLM as compared to Group C (P&lt;0.05). The post-operative VAS score was significantly lower whereas TRA I was significantly longer in Group PLM than in Group C at all measuring times (P&lt;0.05). Conclusion: Combination of paracetamol, magnesium sulfate, and lignocaine attenuates hemodynamic responses during laryngoscopy, intubation, and perioperative period along with prolonged post-operative analgesia in cesarean section under general anesthesia in pre-eclampsia patients.

Evaluation of Pain after Laminectomy Fusion with Fentanyl Transdermal Patch and Paracetamol Infusion: Case Report

Pain can occur due to many things, one of which is trauma and surgical procedures. Fentanyl transdermal patch and paracetamol are analgesics that can be used as alternatives to control the pain. The use of the fentanyl transdermal patch is easy to use because it is needle free, the duration of use can be up to 72 hours, and it is used for chronic with moderate to severe intensity. Paracetamol is also an NSAID that is easy to find and often used. The following is a case series regarding three patients with a diagnosis of Lumbar Tumor at L4-L5 vertebrae, Spinal Cord Injury at C6-C7 vertebrae, Canal Stenosis at L4-S1 vertebrae who received a laminectomy fusion procedure. The three patients received fentanyl transdermal patch and paracetamol therapy as postoperative management. Almost all patients reported a decrease in pain scale after using fentanyl transdermal patch and paracetamol, monitoring pain using the Number Pain Rating Scale (NPRS) and Behavioral Pain Rating Scale (BPS) at the 6th, 12th, 24th and 48th hours postoperatively. Differences can occur due to internal and external factors. In this case, most patients felt a decrease in pain scale at 12 and 24 hours after receiving fentanyl transdermal patch and paracetamol therapy, so that it can be used as an option for postoperative pain management.