Comparison of intravenous butorphanol, ondansetron and tramadol for control of shivering during regional anesthesia: a prospective, randomized double-blind study

We conducted this study to compare the efficacy and safety of butorphanol, ondansetron and tramadol for control of shivering in patients undergoing surgical procedures under spinal anesthesia. In this prospective double-blind, randomized, controlled study, 150 patients of both genders, 18-60 years old, ASA I or II, booked for elective surgery under spinal anesthesia were randomly distributed into three groups of 50 each. Each patient, who developed shivering, was given either 0.03 mg/kg of inj. butorphanol 1% [Group-B], 0.06 mg/kg of inj. ondansetron [Group-O] or 1.0 mg/kg of inj. tramadol 1% [Group-T] IV. Demographic characteristics, incidence of shivering, response rate after 1, 3, 5, 10 and 20 min, recurrence rate, hemodynamic parameters and complications were observed. All patients were relieved of shivering after butorphanol; 66.6% of them were relieved within 1 min, 93.33% within 3 min and 100% within 5 min. Ondansetron could relieve shivering in only 29.4% of the patients; 5.88% within 1, 11.76% within 3, 23.52% within 10 and 29.4% within 20 min. Tramadol relieved shivering in 92.30%; 46.15% within 1, 84.61% within 3 and 92.30% within 5 min respectively [p < 0.05]. Recurrence of shivering was observed in 26.67% of butorphanol group and 15.38% of tramadol group [p> 0.05]. Ondansetron was not found to be much effective for the control of shivering during regional anesthesia. Butorphanol and tramadol were equally effective in controlling shivering under regional anesthesia, the only difference being in their onset of action. Butorphanol was quicker in onset which is essential for control of shivering and should be preferred

Secular Trends in Growth of Preschool Children from Rural Maharashtra, India.

The study examined the secular trends in growth of preschool children from rural Maharashtra, India, during 1985-2001. Anthropometric data collected on preschool (<6 years old) children during 2001 (n=1,171) and 1985 (n=979) from the same villages were compared. Decadal change increased with age and was marginally higher in boys than girls. It was the lowest among infants (-0.1 to 0.1 kg and 0.4 to 0.7 cm in both sexes) and the highest among boys of 4+ years (1.3 kg and 2.9 cm) and girls of 5+ years (1.2 kg and 2.1 cm). Increase in weight was higher (10-15%) compared to that in height (3-5%) and, consequently, reduction in the prevalence of wasting was marked (around 68% in boys and 48% in girls) than that in stunting (42% in boys and 27% in girls) among these children. The improvement was higher in boys than in girls. Negligible secular changes in younger children indicate the need for creating health and nutritional awareness among rural mothers while relatively higher improvement in weight than height among older children warns the future possibility of childhood adiposity even among rural populations.

Awareness and attitude of Indian pregnant women towards labour analgesia

Epidural labour analgesia has not been fully accepted and is not routinely practised in most of the centres in developing countries despite many advantages of this technique. Number of patients who demand labour analgesia is remarkably low in our hospital although the service is available. The aim of this study was to find out the awareness and attitude of pregnant Indian women attending antenatal clinic of our hospital towards labour analgesia. Two hundred consecutive women attending antenatal clinic of our hospital and willing to participate in the study were included in the survey; they were interviewed using a questionnaire that determined their knowledge of and attitudes regarding labour analgesia. Majority of the participants [85%] fell in the age group of 19-25 years [Range 17-36 years] and 89.5% of them belonged to the rural area. Most of them [98%] had no idea about labour analgesia but 95% of the participants expressed their interest to learn about the technique and its advantages. Level of acceptance of labour analgesia after full information was found to be significantly correlated with the level of education and socioeconomic status, fear of delivery complications, and fear of labour pains, and their eagerness to deliver without suffering from labour pains [p<0.05]. It was, however, not correlated to age, geographical distribution, parity, time required for last delivery and perception of intensity of labour pains during last delivery [p>0.05]. Most of the Indian parturients still suffer from agony of labour pains due to lack of awareness. The awareness level needs to be improved about the availability of the labour analgesia service, as majority of them is keen to listen to the information provided. The involvement of obstetricians is crucial in this education program

Comparison of different doses of clonidine as an adjuvant to intrathecal bupivacaine for spinal anesthesia and postoperative analgesia in patients undergoing caesarian section

The necessity to find out the lowest possible effective dose of clonidine to avoid its known side effects like hypotension, bradycardia and sedation prompted us to design present study. We compared different doses of clonidine as an adjuvant to intrathecal bupivacaine for spinal anesthesia in patients undergoing caesarian section aiming to find out the lowest possible effective dose. In a prospective, double-blind, randomized controlled study, 60 parturients 18 to 35 years of age, ASA grade I or II, posted for caesarian section were randomly distributed into three equal groups, BC60, BC30 and BC15. Patients were given 2.0 ml of hyperbaric bupivacaine 0.5% with 60 micro g, 30 micro g or 15 micro g of clonidine intrathecally respectively. Hemodynamic parameters, onset, peak and duration of sensory and motor block, level of sedation and duration of postoperative analgesia were compared. All groups were comparable with respect to demographic profile, onset, peak and duration of sensory and motor block and overall hemodynamic stability. We observed dose dependent variability in duration of analgesia and sedation. Duration of analgesia was significantly higher in BC60 group as compared to the other two groups [598.7 +/- 140.47 vs. 436.65 +/- 149.84 and 387.1 +/- 97.05 minutes respectively]. Sedation was also more in BC 60 group. Addition of 60 micro g clonidine to intrathecal bupivacaine provides longer duration of postoperative analgesia than 15 micro g or 30micro g but with more sedation. We get fairly good analgesia with less sedation in 15micro g and 30micro g clonidine and are better options when sedation is not desirable

Preparing for efficacy trials of vaginal microbicides in Indian women.

Vaginal microbicides are topical compounds that are expected to protect women against vaginal transmission of HIV and other sexually transmitted pathogens. A large number of compounds are being evaluated as possible microbicides. Considering the spread of the HIV epidemic among women in India, clinical trials on microbicides starting from the Phase I safety and acceptability studies to Phase III efficacy trials are important. Conducting efficacy trials is a major endeavour and this review discusses challenges and issues and the preparatory steps to make such efficacy trials possible in India.