A Comparison of Low – Concentration Ropivacaine (0.075%) with Fentanyl Versus Bupivacaine (0.05%) with Fentanyl for Labour Epidural Analgesia

Introduction: Providing effective as well as safe analgesiato the parturients in labour is always a concerned for theanaesthesiologists. We conducted this study to compare theanalgesic efficacy and fetomaternal outcome of ropivacaineand bupivacaine at equianalgesic dose with fentanyl in lowdose infusion.Material and Methods: This prospective, single blind studywas carried on 60 nulliparous parturients of ASA grade Iand II, with uncomplicated singleton, term pregnancy. Thepatients were randomly divided into two groups, to receivebolus dose of either 20 ml of 0.075% Ropivacaine and 0.05%Bupivacaine with fentanyl 2 µg/ml in Group RF and GroupBF respectively, followed by infusion at the rate of 10ml/hr.Onset of analgesia, motor block, maternal hemodynamics,mode of delivery and foetal outcome was assessed.Results: Visual Analog Scale (VAS) score < 3 was achievedin 25 min in Group RF as compared to 30 min in Group BF. At30 min, 77% parturients achieved T10 as compared to 50% ingroup BF. Maternal haemodynamics, APGAR score, umbilicalcord blood analysis was comparable in both the groups. Noneof the patients had motor block in both groups. The percentageof instrumental delivery was more in Group RF.Conclusions: The onset of analgesia was faster in Group RFas compared to Group BF. However once the analgesia wasestablished, both the groups had effective and satisfactoryanalgesia throughout the labour with good foetal outcome.The incidence of instrumental delivery was more in Group RF.

Reproducibility of retinal nerve fiber layer measurements across the glaucoma spectrum using optical coherence tomography.

Purpose: The purpose was to determine intra-session and inter-session reproducibility of retinal nerve fiber layer (RNFL) thickness measurements with the spectral-domain Cirrus optical coherence tomography (OCT)® (SD-OCT) in normal and glaucomatous eyes, including a subset of advanced glaucoma. Materials and Methods: RNFL measurements of 40 eyes of 40 normal subjects and 40 eyes of 40 glaucomatous patients including 14 with advanced glaucoma were obtained on the Cirrus OCT® (Carl Zeiss Meditec, Dublin, CA, USA) five times on 1-day (intra-session) and on five separate days (inter-session). Intraclass correlation coefficient (ICC), coefficient of variation (COV), and test-retest variability (TRT) values were calculated for mean and quadrant RNFL in each group separately. Reproducibility values were correlated with age and stage of glaucoma. Results: For intra-session reproducibility, the ICC, COV, and TRT values for mean RNFL thickness in normal eyes were 0.993, 1.96%, and 4.02 μm, respectively, 0.996, 2.39%, and 3.84 μm in glaucomatous eyes, and 0.996, 2.41%, and 3.70 μm in advanced glaucoma. The corresponding inter-session values in normal eyes were 0.992, 2.16%, and 4.09 μm, 0.995, 2.62%, and 3.98 μm in glaucoma and 0.990, 2.70%, and 4.16 μm in advanced glaucoma. The mean RNFL thickness measurements were the most reproducible while the temporal quadrant had the lowest reproducibility values in all groups. There was no correlation between reproducibility and age or mean deviation on visual fields. Conclusions: Peripapillary RNFL thickness measurements using Cirrus OCT® demonstrated excellent reproducibility in normal and glaucomatous eyes, including eyes with advanced glaucoma. Mean RNFL thickness measurements appear to be the most reproducible and probably represent the best parameter to use for longitudinal follow-up.

Determinants of Indian physicians’ satisfaction & dissatisfaction from their job.

Background & objectives: Physicians’ satisfaction/dissatisfaction from their job is an important factor associated with health service that deals with human life. This study was conducted to ascertain overall level and proportion of physicians’ satisfaction from their job as well as to identify those components that influenced it. Method: A comprehensive customized questionnaire was used with Section A to assess demographic profile of physicians and Section B to assess satisfaction. Response to each question was devised using Likert scale. Likert scale responses were converted to normal scale so that statistical procedures could be naturally developed. A total of 170 physicians were selected using multistage sampling. Questionnaire was administered on one to one basis to avoid non-response. Precise and contextualized descriptive and inferential statistical procedures were used for analysis. Result: Of the 140 physicians, 103 (74%) were satisfied from their job with average score of 19.15 ± 11.46 while 37 (26%) were dissatisfied with average score -09.27 ± 06.30. Nine out of 15 components were found significant (P<0.05). Conclusion: Comparative assessment of the present results with those of other studies revealed that satisfaction percentage of Indian physicians and those of the developed countries were almost the same. Perhaps, magnitude of satisfaction level (average score) of the Indian physicians were towards the lower side. Nine determinants, identified in this study can be used safely to assess any professionals’ satisfaction.