Versus Normal Saline Research Articles

Comparative Analysis of Effect of Lidocaine and Adrenaline Soaked Gauze Versus Normal Saline Soaked Gauze at Skin Graft Donor Site of Thigh: A Randomized Control Trial

Objective: To compare the hemostatic effect of Lidocaine and Adrenaline soaked gauze with normal saline soaked gauze at skin graft donor site of thigh. Study Design: Randomized control trial (Trial ID: NCT04344483). Place and Duration of Study: Plastic & Reconstructive Surgery Department, Dow University of Health Sciences Dr. Ruth K.M. Pfau Civil Hospital, Karachi Pakistan, from Jun to Oct 2020. Methodology: A randomized controlled trial was carried out on 60 Patients under treatment in burn surgery unit. Patients were randomly assigned to 2 groups. Patients in both groups at donor sites received subcutaneous infiltration for 10 minutes, either with 2% Lidocaine and 1:100,000 Adrenaline soaked gauze or with normal saline soaked gauze. Outcomes included intraoperative bleeding, number of dressings required in first 24 hours after surgery, post-operative pain in first 24 hours, systemic analgesia requirement after surgery within 24 hours and donor-site epithelization at 14th post-operatively. Statistical Package for Social Sciences version 25 was used to analyze the data. Results: out of 60 patients, the mean age was estimated as 36.58±12.42 years and 44(73.3%) patients were males while 16(26.7%) were females. Statistically significant difference was observed in number of dressings (p=0.001), mean pain score in first 24 hours (p=0.001), intra-operative bleeding (p=0.001) and systemic analgesia requirement in 24 hours of surgery (p=0.001) between both groups. Conclusion: In comparison to normal saline soaked gauze, the Lidocaine and Adrenaline soaked gauze was effective in terms of number of dressings, pain in first 24 hours, intra-operative

Comparing the Efficacy of Fentanyl Nasal Packing on Postoperative Pain in Patients Undergoing Nasal Surgeries Versus Normal Saline Pack—A Randomized Control Trial

Comparing the Efficacy of Fentanyl Nasal Packing on Postoperative Pain in Patients Undergoing Nasal Surgeries Versus Normal Saline Pack—A Randomized Control Trial

Normal Saline Versus Ringer’s Lactate for Intravenous Fluid Therapy in Children with Diabetic Ketoacidosis: A Randomized Controlled Trial

Normal Saline Versus Ringer’s Lactate for Intravenous Fluid Therapy in Children with Diabetic Ketoacidosis: A Randomized Controlled Trial

Comparative Evaluation of 0.9% Normal Saline Versus Acetate-Gluconate-Based Balanced Solution on Acid-Base Status and Postoperative Liver Function in Donor Hepatectomy Patients.

Background Live donor liver transplantation, a widely practiced procedure, involves resecting a portion of a healthy donor's liver for transplantation. Despite advancements, it poses challenges like cardiovascular instability and electrolyte imbalances, with maintaining acid-base balance being critical. This study compares the effects of 0.9% normal saline and PlasmaLyte A® on acid-base status and postoperative liver function. Methodology This prospective observational study was conducted over one year among 40 healthy adults aged 18-60 years undergoing donor hepatectomy. Patients were alternately allocated to receive either 0.9% saline (Group 1; n = 20) or PlasmaLyte A® (Group 2; n = 20). Key parameters, including acid-base status, hemodynamic parameters, and postoperative liver function, were monitored at various intervals. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 25.0 (Released 2017; IBM Corp., Armonk, NY, USA), with appropriate statistical tests. A p-value <0.05 was considered statistically significant. Results The study included 40 patients, with 20 in each group. No significant differences were observed between the groups concerning age, gender, weight, hemodynamic parameters, and urine output. However, significant differences were found in acid-base parameters. Group 2 showed better preservation of acid-base balance with higher pH and HCO₃ levels. Patients in Group 1 exhibited a significant decrease in HCO₃ levels during surgery, while those in Group 2 maintained a more stable metabolic profile. Furthermore, nine patients in Group 1 required sodium bicarbonate supplementation for metabolic acidosis, compared to only three in Group 2. Postoperative liver function tests revealed no significant differences between the two groups, although a trend toward better outcomes was observed in Group 2. Conclusions PlasmaLyte A® demonstrated superior preservation of acid-base balance compared to 0.9% normal saline, with less need for bicarbonate supplementation. While liver function outcomes were similar, the balanced solution showed a trend toward better metabolic stability, suggesting it may offer safer and more effective fluid management in liver transplantation surgery.

Effect of Wound Irrigation with Povidone Iodine Versus Normal Saline on Superficial Incisional Surgical Site Infection Following Laparotomy for Peritonitis

Abstract Background: Peritonitis is a surgical emergency arising mostly from the perforation or rupture of an abdominal hollow viscus. Surgical operations for peritonitis are often attended by high morbidity and sometimes mortality in severe cases. Surgical site infection (SSI) is perhaps the most common post-operative morbidity following laparotomy for peritonitis. Objective: To compare the rate of SSI in abdominal operations for peritonitis following wound irrigation with povidone iodine versus normal saline at a tertiary health institution in Nigeria. Materials and Methods: This was a prospective, comparative hospital-based study over a year. Consecutive consenting adult patients were randomised into two groups in this study. The first group (A) used 500 mL of 1% povidone iodine for subcutaneous wound irrigation, while the second group (B) used 500 mL of normal saline for subcutaneous wound irrigation. Wound irrigation was done after an appropriate surgical procedure had been carried out based on the pathology. Wounds were assessed for SSI for up to 30 days after operation using the definition criteria by the Centre for Disease Control and Prevention (CDC). SSI rates were compared between the two groups. Result: Fifty-eight consecutive patients with generalised peritonitis over a one-year period were enrolled in this study, but 53 patients who completed the study were analysed. Thirty patients were males and 23 were females, and their mean age was 40.83 ± 17.96 years. Overall, 15 (28.3%) patients had incisional SSI. There were nine (34.6%) cases in the povidone group, while there were six (22.2%) in the saline group. This difference was not statistically significant (P = 0.32). Klebsiella species were the dominant organisms isolated from the infected wounds. Conclusion: Wound irrigation with povidone iodine after laparotomy for peritonitis did not reduce the rate and severity of surgical site infection more when compared to normal saline. We suggest further studies with a large number of patients in a multi-centre study to explore further the effect of povidone iodine versus normal saline wound irrigation on SSI following laparotomy for peritonitis.

Balanced Fluids Versus Normal Saline for Initial Fluid Resuscitation in Adults With Diabetic Ketoacidosis.

Background: Normal saline (NS) has been the choice fluid for volume resuscitation in diabetic ketoacidosis (DKA) for decades. Large volume resuscitation with NS can lead to hyperchloremic metabolic acidosis and is associated with a higher incidence of major adverse kidney events compared to balanced fluids (BF). Objective: Compare safety and effectiveness of fluid resuscitation with BF vs NS in adult patients with DKA. Methods: Single-center retrospective cohort study evaluated patients who received NS or BF for DKA treatment between July 2020 and August 2021. Primary endpoint was time to DKA resolution. Secondary endpoints included time to anion gap ≤12, HCO3 ≥15 and ≥18mmol/L, acute kidney injury, and hospital and intensive care unit length of stay. Results: 110 patients were included (NS 55% (n = 60), BF 45% (n = 50)). Time to DKA resolution was faster in patients who received BF vs NS (13 (10 - 19) hours vs 17 (11 - 25) hours, P = 0.02). Treatment with NS was associated with a longer time to resolution of DKA when adjusted for initial bicarbonate and AKI at admission. Conclusion: BF was associated with a shorter time to DKA resolution compared to NS.

Compared the Effectiveness of Intraperitoneal Bupivacaine with Lung Recruitment Maneuver Versus Normal Saline with Lung Recruitment Maneuver in Reducing Shoulder Pain After Laparoscopic Surgery: A Double-Blind Randomized Controlled Trial.

Postoperative shoulder pain is one of the most common complications following laparoscopic surgery. Various interventions have been proposed to control this pain. The main objective of this comparative study was to determine the effects of intraperitoneal bupivacaine and normal saline infusion, in combination with lung recruitment maneuver (LRM), on shoulder pain following laparoscopic surgery. The present randomized controlled trial was conducted on 105 candidates for laparoscopic cholecystectomy referred to Imam Ali Hospital in Bojnurd, Iran, from November 2021 to June 2022. The patients were assigned to three groups using block randomization: BR (receiving 50 cc of 0.25% diluted intraperitoneal bupivacaine + LRM), NR (receiving 50 cc of intraperitoneal normal saline + LRM), and N (receiving 50 cc of intraperitoneal normal saline). Postoperative shoulder pain and surgical incision site pain were assessed using the Visual Analogue Scale (VAS) at recovery intervals of 4, 12, 24, and 48 hours after surgery. Additionally, the prevalence of nausea and vomiting, the first time of need for sedation, and the incidence of sedation overdose in the first 24 hours after surgery were investigated. The data were analyzed using one-way analyzed by one-way analysis of variance (ANOVA) with SPSS software at a significance level of 0.05. The findings showed no significant differences in demographic variables between the three groups. The range and mean score of shoulder pain based on VAS was 0 - 1 (0.3) in the BR group, 0 - 2 (1.4) in the NR group, and 1 - 3 (2.1) in the N group at 4 hours after surgery. The mean score of shoulder pain intensity in the BR group was lower compared to the NR and N groups during recovery time intervals at 4, 12, and 24 hours after surgery. This difference between groups was significant. There was also a statistically significant difference in the mean score of surgical incision site pain intensity and the first time of need for sedation between the three groups. The occurrence of side effects was not significant between the groups. Itching, bradycardia, and hypotension were not observed in any of the groups. The findings of this study showed that bupivacaine, along with LRM, is a safe method effective in relieving postoperative shoulder pain. It prolonged the first time of need for sedation and significantly reduced the incidence of shoulder pain.

Immediate Postoperative Outcome of Peritoneal Lavage with Povidone-Iodine Based Normal Saline Versus Normal Saline in Duodenal Ulcer Perforation

Immediate Postoperative Outcome of Peritoneal Lavage with Povidone-Iodine Based Normal Saline Versus Normal Saline in Duodenal Ulcer Perforation

Outcome of Post Functional Endoscopic Sinus Surgery Nasal Irrigation with Normal Saline Versus Normal Saline with Budesonide in Patients with Sinonasal Polyposis: A Randomized Control Trial.

Chronic rhinosinusitis(CRS) is a condition characterized by inflammation of the lining of nose and sinuses lasting for 12weeks or more. CRS with nasal polyp nasal polyp(CRSwNP) is seen in 0.5-4% of the population and is present in about 20% of patients with CRS. Functional endoscopic sinus surgery aids in restoring the ventilation and drainage of paranasal sinuses. Postoperatively, various solutions are used to irrigate the sinus cavity for pharmaceutical and mechanical lavage. Hence, it is imperative to compare different solutions to choose the best to give a favorable outcome. A total of 24 postoperative CRSwNP patients were randomly divided into two groups. Group A received routine post-FESS medication as per the institute guidelines. Group B received budesonide nasal irrigation in addition to regular care. Both groups were evaluated endoscopically at 1, 4, and 12weeks after the surgery. Pre and postoperative quality of life were compared. Endoscopic Lund-Kennedy scoring (objective measurement) and Sino-Nasal Outcome Test 22 score were used to compare the two groups. The mean preoperative Sino Nasal Outcomes Test 22 score(SNOT-22) was 46.58 ± 6.18 in group A and 50.5 ± 5.7 in group B. It was reduced to 15.00 ± 2.00 and 9.75 ± 1.95 postoperatively in both groups respectively at the end of 3months. Postoperatively, the mean endoscopic score was 2.36 ± 0.80 in group A and 1.18 ± 0.40 in group B at the end of 3months. In conclusion, saline plus budesonide nasal irrigation is a better option when compared to saline only irrigation in terms of efficacy and therapeutic effect in patients undergoing FESS for CRSwNP, hence, it should be advocated in regular clinical practice.

Comparing the Efficacy of Povidone-Iodine Versus Normal Saline in Laparotomy Wound Irrigation to Prevent Surgical Site Infections: A Meta-Analysis.

Surgical site infections (SSIs) are a known complication of laparotomies and intra-abdominal surgical operations leading to remarkable consequences on mortality, morbidity, and expenses. The study aims to assess the efficiency of irrigating laparotomy incision sites with povidone-iodine (PVI) or normal saline (NS) in diminishing the rate of SSIs in patients undergoing gastrointestinal operations for varying indications. Randomized controlled trials (RCTs) highlighting the contribution of laparotomy wound irrigation with PVI in opposition to NS in patients planned for laparotomy addressing numerous gastrointestinal issues, and their role in reducing SSI risk were obtained via searching of standard electronic medical databases. The analysis was conducted by utilizing meta-analysis principles procured by statistical software RevMan version 5.3 (Cochrane Collaboration, London, UK). The yield of medical databases exploration and inspection was 13 RCTs on 3816 patients who underwent laparotomy for different gastrointestinal operations. There were 1900 patients in the PVI group whereas 1916 patients received NS wound irrigations preceding closure of the laparotomy skin wound. In the random effects model analysis, the use of PVI for laparotomy wound irrigation was associated with the reduced risk (odds ratio = 0.54, 95%CI (0.30, 0.98), Z = 2.04, P = 0.04) of SSIs. Nevertheless, there was outstanding heterogeneity (Tau2=70; chi2=40.19, df=12; P = 0.0001; I2=70%) among the included studies. According to the comprehensive analysis outcomes, it has been clinically proven that the use of PVIis highly effective in reducing the occurrence of SSIs, as well as their subsequent implications.

Comparison of Fluid Resuscitation with Lactate Ringer's Versus Normal Saline in Acute Pancreatitis: An Updated Meta-Analysis.

Fluid resuscitation is one of the main therapies for acute pancreatitis (AP). There is still no consensus on the type of fluid resuscitation. This study investigated the differences between lactate Ringer's (LR) and normal saline (NS) in treating AP. Two authors systematically searched Web of Science, Embase (via OVID), Cochrane Library, and PubMed to find all published research before July, 2023. The odds of moderately severe/severe AP and intensive care unit (ICU) admission are set as primary endpoints. This meta-analysis included 5 RCTs and 4 observational studies with 1424 AP patients in LR (n = 651) and NS (n = 773) groups. The results suggested that the odds of moderately severe/severe AP (OR 0.48; 95%Cl 0.34 to 0.67; P < 0.001) and ICU admission (OR 0.37; 95%Cl 0.16 to 0.87; P = 0.02) were lower in the LR group compared to NS group. In addition, the LR group had lower rates of local complications (OR 0.54; 95%Cl 0.32 to 0.92; P = 0.02), lower level of CRP, as well as a shorter hospital stay (WMD, - 1.09days; 95%Cl - 1.72 to - 0.47days; P < 0.001) than the NS group. Other outcomes, such as mortality, the rate of organ failure, SIRS, acute fluid collection, pancreatic necrosis, pseudocysts, and volume overload, did not differ significantly between two groups (P > 0.05). LR is preferred over NS as it decreases the odds of moderately severe/severe AP, the rate of ICU admission, local complication, and length of hospital stay. However, large-scale RCT are lacking to support these evidence.

Comparison of Intraperitoneal Irrigation With Sodium Bicarbonate Versus Normal Saline in Reducing Pain After Operative Laparoscopy: A Randomized Controlled Trial.

Background It has been postulated that sodium bicarbonate can reduce postoperative pain by neutralizing the acidic peritoneal environment created by carbon dioxide. It also prevents phrenic nerve damage and peritoneal irritation. The present study is a randomized controlled trial aimed at studying the effects of sodium bicarbonate in reducing postoperative pain in laparoscopic gynecological surgeries. Materials and methods This was a single-center, prospective, two-arm, double-blinded randomized control trial in which intraperitoneal irrigation with sodium bicarbonate was compared with normal saline in operative laparoscopy. Group I (intervention group) consisted of 40 patients who received intraperitoneal sodium bicarbonate, and Group II (control group) consisted of 40 patients who received normal saline. All procedures were conducted under general anesthesia. Postoperative pain scores were compared between intervention and control groups. Results The most common indication of laparoscopy was infertility. There was no difference in the duration of surgery between the two arms (p=0.27). The mean value of the visual analog scale (VAS) score at the shoulder tip was found to be significantly reduced in the intervention group at two hours (p=0.02), four hours (p=0.0009), and 12 hours (p=0.0002) after surgery. The mean VAS score at the abdomen and port sites was also found to be significantly reduced in the intervention group in the first 24 hours after surgery (p<0.05). With the increase in the time period from surgery, the mean VAS scores decreased in both intervention and control groups. Conclusion Intraperitoneal irrigation with sodium bicarbonate is beneficial in reducing postoperative pain in operative laparoscopy. However, multicenter randomized trials with a greater number of participants will be helpful to confirm the findings.

Balanced Crystalloids Versus Normal Saline in Noncritically Ill Adults with Sickle Cell Disease Admitted from the Emergency Department: A Sub-Analysis of the Salt-ED Trial

Background: Common acute manifestations of sickle cell disease (SCD), including vaso-occlusive pain episodes (VOE) and other complications, are often treated in the emergency department (ED). Effective treatment in the ED remains challenging and often only includes supportive care, such as analgesics and intravenous (IV) fluids. There is clinical equipoise regarding the type of IV fluid to use for resuscitation, and while normal saline (NS) is the most commonly one used in the ED, some SCD providers discourage use of NS. Patients with SCD and kidney dysfunction, who are often at-risk for acidosis already, may not effectively excrete the high sodium, hyperosmolar load of NS, and in large volumes NS may cause hyperchloremic metabolic acidosis that could impact sickle red blood cell (sRBC) rheology (Nath, Nat Rev Nephrol, 2015). We recently demonstrated modestly hyperosmolar and acidotic fluids like NS (308mOsm/L, pH=5.5) may dehydrate sRBCs, increase sRBC/endothelium adhesion, and worsen deformability; and we also showed NS bolus use in pediatric pain management in the ED was associated with inferior pain control, increased likelihood of hospital admission, and more time spent in the ED (Carden et al., Blood & AJH, 2017&2019). Rigorous studies examining the impact of IV fluids, particularly NS, during ED management of adults with SCD have not been performed, and recent evidence suggests that balanced crystalloids (B) may be safer for resuscitation of adults in the ED. Methods: We utilized data from the seminal SALT-ED study, a single-center, pragmatic, multiple-crossover prospectively randomized controlled trial (RCT) that compared outcomes related to administration of balanced crystalloids (primarily lactated ringers [LR], 274mOsm/L, pH=6.5) to NS administration to all-comer adult patients in the ED (Self et al., NEJM, 2018). Using ICD-10 codes, we conducted an intention-to-treat sub-analysis of SCD patients in the SALT-ED trial. Enrolled participants were non-critically ill adults (18 years and older) with SCD who presented to the ED and were subsequently hospitalized to a non-ICU bed at the hospital. Chief complaint was captured when available. The primary outcome examined was median hospital free days post-index hospitalization and secondary outcomes included a composite of adverse kidney events and death (i.e. MAKE30), as well as changes in serum electrolyte status. Results: There were 150 adults with SCD identified in the SALT-ED study (Table 1a). Of 13,347 visits captured, 247 ED visits were attributed to these 150 patients - N=126 visits (51%) in the B group and N=121 (49%) in the NS group. Over 50% of documented chief complaints in the ED were pain-related. Compared to all adult patients in the SALT-ED study, those with SCD were younger, more likely to identify as female and Black, have a lower baseline creatinine, and while having similar hospital free days and similar volumes of crystalloids administered in the ED, patients with SCD had an approximate 3.5 times higher odds of suffering an acute kidney injury event (i.e. MAKE30 endpoint) during hospitalization. Compared to those with SCD randomized to the B group, those patients with SCD in the NS group had more adverse kidney events, increased mean length of hospital stay, higher maximum in-hospital sodium, higher maximum in-hospital chloride, and lower minimum in-hospital bicarbonate, suggesting an increased risk of high sodium acidosis with NS use in the ED (Table 1a&b). Using combined data from both groups and analyzing with linear regression, we found in-hospital electrolyte levels were significantly associated with hospital length of stay among adults with SCD administered IV fluids in the ED (Table 1c). Conclusion: The results from this large RCT sub-analysis further support recent evidence suggesting NS is not an ideal resuscitation IV fluid for adults with SCD presenting to the ED with pain and other complications. Adult patients with SCD randomized to NS in the ED had higher rates of in-hospital high sodium levels, metabolic acidosis, increased hospital stay, and increased kidney events. Our findings suggest that administering balanced crystalloids like LR may be a better option for IV fluid resuscitation among adults with SCD presenting to the ED. Further research is needed to confirm these findings and to determine the optimal IV fluid regimen for adults with SCD presenting to the ED with VOE or other complications. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Outcome of Hypertonic Saline Versus Normal Saline in Children with Acute Bronchiolitis

Objective: To compare outcome of hypertonic saline (HS) versus normal saline (NS) among children aged 2 to 24 months with acute bronchiolitis. Study design: An open label randomized controlled trial. Place and Duration of the Study: Department of Pediatric Medicine, Ibn-e-Siena Hospital, Multan from 1st September 2021 to 31st March 2022. Methodology: A total of 220 children (110 in each group) of both genders aged 2 to 24 months reporting to emergency department with acute bronchiolitis with a disease spanning less than 5 days were included. In HS group, children were nebulized with 4 ml of 3% HS while in NS groups, all children were nebulized with 4ml 0.9% saline solution. In both groups, children were given respective treatment with interval gap of 4 hours. Clinical severity score and need for hospitalization after 24 hours was noted. Results: In a total of 220 children, 126 (57.3%) were males and 94 (42.7%) females. Overall, mean age was 7.9±5.3 months while 170 (77.3%) children were aged between 2 to 12 months. Residential status of 132 (60.0%) children was rural. Monthly family income of 165 (75.0%) children was below 25,000 Pakistani Rupees (PKR). Maternal educational status of 91 (41.4%) children was illiterate. Mean baseline clinical severity score was calculated to 7.28 ± 1.47. HS group, post-treatment mean clinical severity score was 4.29±2.83 in comparison to 5.99±2.64 in NS groups. There were 28 (25.5%) children in HS group who required hospitalization in comparison to 56 (50.9%) in NS group (p=0.0001) Conclusion: In comparison to nebulization with normal saline, nebulization with hypertonic saline solution was found to be significantly more effective in reducing clinical severity score and need for hospitalization among children aged up to 2 years with acute bronchiolitis. Keywords: Hypertonic saline, normal saline, acute bronchiolitis, clinical severity score.

Comparison of the Outcome of Gentamycin Lavage Versus Normal Saline Lavage for Axillary Dissection in Modified Radical Mastectomy

Aim: To compare the gentamycin lavage with normal saline lavage after axillary dissection in modified radical mastectomy in terms of mean postoperative wound drainage was the objective of this study. Material: This Randomized controlled trial was conducted at Department of Surgery, Jinnah Hospital Lahore form July, 2018 to June, 2019. Total 100 female patients with 30 to 60 years of age, who underwent modified radical mastectomy for breast cancer. The patients were divided into two groups; group A (operative wound washed with 500ml normal saline) and B (wound washed with 500ml of gentamycin solution (240mg) in addition to the 500ml of normal saline). Results: Mean age and BMI of patients were 49.60±5.83 vs. 49.50±6.723 years (p=0.937) and 27.02±2.90 vs. 27.12±3.33 kg/m2 (p=0.873), in group A and B, respectively. Mean wound drainage were 356.46 ± 59.11 vs. 317.42 ± 51.92 ml (p=0.001), in group A and B, respectively. Conclusions: Gentamycin lavage reduces the postoperative axillary wound drainage after modified radical mastectomy as compared to normal saline lavage. Keywords: Gentamycin Lavage; Axillary Dissection; Modified Radical Mastectomy

Comparison of Low Dose Ketamine Versus Normal Saline in Prevention of Postoperative Shivering

Background: Shaking is a frequent adverse effect of anesthesia, which may potentially exacerbate the discomfort. It is characterized by involuntary muscular contractions that can affect many muscle groups. It is extremely unpleasant and physically demanding. Objective: The purpose of this study is to examine the efficacy of Low Dose Ketamine against normal saline in preventing postoperative trembling. Study Design: Randomized Controlled Trial. Setting: Department of Anesthesiology, Khyber Teaching Hospital, Peshawar. Duration of Study: This study was conducted from 1st July 2020 to 31st December 2020. Subjects and Methods: Sixty male and female patients who volunteered for lower abdominal surgery were studied. Each block of six was shuffled before the randomization procedure began. Thirty people made up the Low Dose Ketamine group (A), and the Normal Saline group (B) (B). After 30 minutes, the Crossley and Mahajan scale was used to measure the degree to which both groups were shivering after the surgical incisions had healed. This was done so that we could gauge the accuracy of the measuring device. Results: Age range in this study was from 20 to 60 years. Efficacy was observed in 28 (93.3%) patients in group A as compare to 16 (53.3%) patients in group B (P= 0.000). Conclusion: As a consequence of this research, it appears that 0.25 mg/kg of ketamine is an effective dose for minimizing postoperative shivering after elective surgery. Keywords: Postoperative shivering, Low dose ketamine, Efficacy

Comparison of Honey Versus Normal Saline in the Management of Post-Operative Infected Wounds in Pediatric Urology Patients

Introduction: Honey exhibits a variety of bacteriostatic and bactericidal factors. Due to its variety of antimicrobial and wound healing properties, honey is an effective remedy in wound infections even caused by microorganisms resistant to antibiotics. Nevertheless, there are many known benefits of normal saline soaked gauze dressing as well such as its osmotic properties, cost-effectiveness, and easy availability with no side effects. It is believed that honey as well as normal saline could be used in the management of infected and non-healing wounds and ulcers, pressure wounds, burns, boils, pilonidal sinuses, diabetic and venous ulcers and even malignant wounds with respect to wound size and cleanliness. Purpose of Study: The purpose of this study is to compare the effect of topical honey versus normal saline soaked dressing application in the management of cosmetically improved postoperative infected wounds in pediatric urology patients. Material and Methods: This Randomized Controlled trial was conducted at the Institute of Kidney Diseases (IKD), Hayat Abad Medical Complex (HMC), Peshawar commencing from January 2019 till December 2019 i.e., over a period of one year. Pediatric patients with postoperative wound infections with positive wound cultures were included in the study. The patients were divided into two groups. In group A normal saline soaked dressing was applied and in group B honey was applied three times a day each. Results: A sample size of 60 patients was taken with males 35(58.3%) and females 25(41.7%). Mean age was 5 years with standard deviation of 2.15 with minimum age 1 year and maximum age 10 years. The bacteria on wound culture came out to be Pseudomonas aeruginosa, Staphylococcus aureus and Escherichia coli in descending order. Patients were divided into two groups. Group A included 30 patients with normal saline soaked dressing application to the wound while Group B included 30 patients with honey application to the infected wound. Both groups were compared in terms of scar improvement and results were found statistically significant 0.028 in group B (Honey). Conclusion: Honey can be used safely and effectively for the management of postoperative surgical site infections in pediatric urology patients as compared to normal saline soaked dressings. Keywords: Honey, postoperative infected wound, pediatric patients

Effect of Topical Insulin Versus Normal Saline Dressing in Healing of Diabetic Foot Ulcers

Diabetic foot ulcer is a common cause of admission in the surgical wards and sometimes the first presentation of this debilitating disease. Numerous topical medication and gels are promoted for ulcer care and healing. Relatively few have proved to be more efficacious than normal saline dressing. This study aimed to compare the effect of topical insulin versus normal saline dressing in healing of diabetic foot ulcers at Rajshahi Medical College Hospital, Rajshahi.&#x0D; Aims and objectives: To assess the effect of topical insulin versus normal saline dressing in healing of diabetic foot ulcers.&#x0D; Methods: A total of 60 patients with diabetic foot ulcers were studied in different units of surgical ward of Rajshahi Medical College Hospital from July 2017 to June 2019. Patients were divided into two groups of 30 patients each that is group A (topical insulin) and group B (Normal saline). Ratio, mean, standard deviation, Pearson Chi-Square test were applied appropriately to this study.&#x0D; Results: Among the 60 patients, majority of the patients were males in both the groups (73.33% in group A and 80.00% in group B) with male to female ratio of 2.7:1 in group A and 4:1 in group B. The mean age in group A was 50.00±7.33 years and in group B it was 53.00±7.80 years, where P=1.00. Among patients with group A significant reduction of mean ulcer area was observed (314.30±171.26 mm2 ) with higher mean percentage reduction (15.30±3.28 percent), whereas, in group B the mean percentage reduction was significantly less (6.35±2.03 percent) with less reduction of mean final ulcer area (110.5±56.23mm2), where P&lt;0.001.&#x0D; Conclusions: Topical insulin dressing provided better outcome in patients with diabetic foot ulcers by significant reduction in wound area when compared to normal saline dressing.&#x0D; Central Medical College Journal Vol 5 No 2 Jul 2021 PP 94-101

Fluid Resuscitation With Lactated Ringer's Solution Versus Normal Saline in Acute Pancreatitis: A Systematic Review and Meta-Analysis of Randomized Trials.

We aimed to perform a systematic review and meta-analysis of randomized controlled trials to summarize the overall association between the choice of fluid (lactated Ringer's [LR] or normal saline [NS]) and clinical outcomes in patients with acute pancreatitis. A systematic literature search was performed in electronic databases to identify eligible randomized controlled trials. Meta-analyses with the random-effects and IVhet models were used to estimate the pooled odds ratio (OR) for outcomes of interest with the administration of LR relative to NS, at 95% confidence intervals (CIs). There was a significant reduction in the odds of intensive care unit admission and development of local complications, respectively, with the administration of LR among hospitalized patients with acute pancreatitis relative to administration of NS (pooled ORs, 0.33 [95% CI, 0.13-0.81] and 0.43 [95% CI, 0.21-0.89], respectively). Our findings are able to assist clinicians in the navigation of the proper choice of fluid in patients with acute pancreatitis.

Heparin Versus Normal Saline: Flushing Effectiveness in Managing Central Venous Catheters in Pediatric Patients With Cancer.

There is insufficient evidence of the effects of intermittent flushing with normal saline versus heparin to prevent occlusion or increased alteplase use in pediatric patients with central venous catheters. The primary objective was to evaluate the effectiveness of a new standard flushing practice in the management of central venous access devices in pediatric patients with cancer. A secondary objective was to assess the cost of heparin flushing supplies to patients and financial impact. New flushing guidelines included tunneled lines flushed with saline in the push-pause method twice daily in the inpatient setting. The outpatient setting required saline lock while receiving care and heparin lock on discharge. Alteplase usage was monitored for five months in all pediatric patients with cancer who had tunneled central lines. There was no statistically significant difference in alteplase usage rate pre- to postimplementation. A formal flushing guideline was recommended using saline and lower heparin concentrations for tunneled catheters.