Dexamethasone as an adjuvant to bupivacaine for post operative pain in supraclavicular branchial plexus block

To compare the onset of block, duration of analgesia and complications when dexamethasone is added to local anaesthetic bupivacaine in supraclavicular brachial plexus block for upper limb surgery. Quasi experimental study. This study was conducted at the Department of Anaesthesia, PIMS, Islamabad from July 2007 to June 2008. total sixty patients were included in this study. 30 patients were given supraclavicular block with 0.5% Bupivacaine plus normal saline and put in Group A and remaining 30 were given 0.5% bupivacaine plus dexamethasone and put in Group B. Study inclusion criteria were surgery of upper limb, age of the patient between 20 years to 60 years and anaesthesia physical status [ASA] I, II, III. Variables recorded were onset of sensory and motor block for both groups and duration of sensory and motor block in both groups. Rescue analgesia requirement and complications were also noted in both groups. Demographically both groups were well watched T. test was used to compare the onset of sensory and motor block, duration of sensory and motor block and numerical pain score between the two groups. Chi-squre test was used to compare rescue analgesia required and complications between the two groups. P-value less than 0.05 was considered statistically significant. The onset of motor block was similar in both groups [p-0.82] while onset of sensory block was earlier in dexamethasone group [p-0.014]. The duration of sensory and motor block were significantly longer in dexamethasone group [B] than Bupivacaine group alone [A] [P=<0.001]. Rescue analgesia required by the bupivacaine alone [A] was much earlier than dexamethasone group [B] [P= < 0.001]. No serious complications were noted in both groups. The addition of dexamethasone to bupivacaine 0.5% solution in supraclavicular brachial plexus block prolongs the duration of sensory and motor blockade and provides greater pain relief also it shorten the onset of sensory block but has no effect on onset of motor block

How much blood transfusion protocols are followed among health care providers in the tertiary care hospitals of Rawalpindi and Islamabad

The high-ceilinged importance given to safe blood transfusion, a study was conducted in the teaching hospitals of Islamabad and Rawalpindi to ascertain how much blood transfusion protocols are followed. Cross sectional study. This study was carried out in the Teaching Hospitals of Islamabad and Rawalpindi, between Oct, 2007 to Dec, 2007. A total of seventy six health care professionals from surgical and allied specialties were put forward a questionnaire Performa relating to as to whether departmental guidelines for blood transfusion are followed or not. Out of total studied sample i.e. seventy six in total, forty health care personals i.e. 52.63% affirmed that they do follow departmental guidelines for blood transfusion, whereas thirty six personals i.e. 47.37% were lacking the follow-up of standard protocols in their settings. In the study 47.37% i.e. thirty six in number of considered health care professionals were of the opinion that they do not pursue in spirit departmental guidelines regarding blood and blood product transfusion

Effectiveness of combined thoracic epidural and light general anaesthesia in patients undergoing non-cardiac thoracic surgery

The specialty of thoracic anaesthesia has emerged as a scientifically based discipline just 30 years back. At the start of the 20'1i century empyema and tuberculosis were the main indications for the thoracic surgery. Later on with the introduction of antibiotics lung malignancies were more commonly operated. Recent resurgence of tuberculosis and associated medical illnesses put these patients in high risk for surgery and anaesthesia, necessitating introduction of more skilful approach. The objective of this study was to evaluate the effectiveness of combined thoracic epidural anaesthesia and light general anesthesia in patients undergoing non-cardiac thoracic surgery. This study was conducted at the department of Anesthesia and Intensive care, Pakistan Institute of Medical Sciences, Islamabad from 1st Jan 2001 to 31st August 2002. Ten adult patients of both sexes of ASA grade I-III, < 68 years of age, who were undergoing non-cardiac thoracic surgery were included. Thoracic epidural and central venous lines were placed 20 to 30 minutes before the start of procedure. All patients received same premedication, induction agents, analgesics, inhalational agents and muscle relaxants. All patients were transferred to Surgical Intensive Care unit after completion of the procedure. Seventy% patients were operated on lungs, twenty% on mediastinum and one% for carcinoma of esophagus. Only one patient had co morbid disease of hypertension. One patient [10%] died of massive intraoperative hemorrhage. One patient [10%] developed superior vena caval obstruction, that was to be operated for mediastinal growth. Rest of eight [80%] patients were extubated in the operation theatre. All [100%] patients received intraoperative blood transfusion. 20 patients required additional analgesia in the postoperative period. 20% developed postoperative arrhythmias. Combined use of light general anaesthesia and thoracic epidural is effective in patients undergoing non-cardiac thoracic surgery