comparative study of sciatic nerve block for leg and foot surgery in elderly patients with the help of nerve locator vs paraesthesia elicitation technique

Commonly used methods of performing peripheral nerve blocks include elicitation of paresthesia and motor response to an electrical stimulus. The objective of this study was to compare the efficacy and reliability of these two methods in performing sciatic nerve block for lower limb surgery in elderly patients. Sixty patients, 60 - 90 years of age were randomly divided into two groups in this observer blinded study. In Group I Sciatic nerve block was established with a nerve locator and in group II paraesthesia elicitation technique was used. 20 ml of 0.5% bupivacine was administered in both groups. Haemodynamic parameters were recorded before and after the sciatic nerve block. We recorded the time of onset and extent of both sensory and motor blocks. The severity of pain was also noted in both groups. Statistically significant differences were seen in depth of sensory and motor blocks and degree of pain between groups [P < 0.05]. The time of onset of block was same in both groups and haemodynamics remained stable before and after the block. The use of nerve locator is more effective and successful in performing peripheral nerve blocks in comparison to paresthesia elicitation technique

Comparison of haemodynamic effects of unilateral versus bilateral spinal anaesthesia in adult patients undergoing inguinal hernia repair

The haemodynamic changes encountered in spinal anaesthesia are directly related to the extent of sympathetic block and can be decreased by restricting the block to unilateral sympathetic chain. This prospective quasi experimental study compared the changes in heart rate and blood pressure in unilateral and bilateral spinal anaesthesia to demonstrate that unilateral block caused less haemodynamic changes. Sixty ASA I or II patients aged 20 - 60 years for elective inguinal herniorrhaphy were randomly divided into two groups: group - A [unilateral] and group - B [bilateral]; each having 30 patients. Hyperbaric bupivacaine [15 mg] was injected intrathecally in lateral position. Group A patients were kept in lateral position with surgical side down for 10 minutes. In group B, patient's position was immediately changed to supine. Blood pressure and heart rate were recorded prior to and at every 5 - minute intervals after spinal anaesthesia for a duration of 30 minutes. Chi-square and t-test were applied. Frequency of hypotension was 6.7% in group A and 60% in group B [p = 0.00]. Frequency of bradycardia was 6.7% in group A vs. 10% in group B [p = 0.50] while the frequency of tachycardia was 3.3% in group A and 16% in group B [p = 0.09]. Frequency of hypotension was significantly less in unilateral as compared to bilateral spinal anaesthesia

Frequency of dyslipidemias in diabetic patients at combined military hospital Multan

To determine the frequency of dyslipdemias in diabetic patients at Combined Military Hospital Multan. Cross sectional observational. Department of Medicine, Combined Military Hospital Multan from February 2007 to August 2007. Diabetic patients aged between 30-70 years of either gender and having diabetes for >5 years were included in the study. Patients with co-existent hypothyroidism, chronic renal failure, nephritic syndrome, familial hypercholesteremic syndromes, already on lipid lowering drugs, anti-hypertensive drugs, using beta blockers or thiazide diuretics, obese patients with BMI > 30 and those using alcohol were excluded. Blood samples after overnight 10 hours fasting were taken for plasma glucose, serum total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides. Frequency of dylipideamias was analysed using Statistical Package for Social Sciences [SPSS] version 10. Mean age of 200 diabetic patients included in the study was 51 +/- 9.47 years [range 34-70 years] and male to female ratio of 1.21:1. Mean fasting plasma glucose levels of the diabetic patients was 8.2 +/- 2.2 mmol/L. Out of 200 patients, dyslipideamia was present in 163 [81.5%] patients. Hypertrglyceridemia was present in 150[75%] patients, raised LDL-cholesterol in 126 [63%] patients, decreased HDL-cholesterol in 119 [59.9%] patients, and raised levels of total cholesterol in 89 [44.5%] of the patients. Diabetic patients have a high frequency of dyslipidemias especially raised triglycerides, therefore lipid profile is to be checked routinely and its management be given equal importance in addition to glycemic control

Determination of glycosylated hemoglobin reference range in adult population attending a military care set up in Rawalpindi

To determine the glycosylated hemoglobin reference range in healthy adult population attending a military care setup in Rawalpindi in accordance with National Glycohemoglobin Standardization Program [NGSP] and International Federation of Clinical Chemistry [IFCC]. Descriptive cross-sectional study. Armed Forces Institute of Pathology Rawalpindi from May- Oct 2010. A total of 254 healthy adults [18-80 years] comprising 169 males and 85 females, were included by non probability consecutive sampling from Rawalpindi. History and clinical examination were carried out. Blood HbA1c was analyzed high performance liquid chromatography on biorad D-10. Data were analyzed by SPSS-17. Total 254 subjects consisting of 169 males and 85 females were recruited from Rawalpindi Pakistan. The reference range of total population was found 4.6-6.56% and 2.69-4.81 mmol/ mol in accordance with NGSP and IFCC, respectively. When compared in gender, HbA1c levels were not significantly changed. However, the healthy elderly population had higher HbA1c levels. Reference range for HbA1c based on NGSP in individuals <40 years was found 4.52-6.4% while for individuals aged > 40 years, it was 4.8-6.68%. The reference ranges for healthy individuals and the recommended values for optimal therapy in diabetic patients have to be revised and adjusted. Population based reference ranges should be established to provide better patient care services

Causes of postponement of elective surgery in Mayo hospital Lahore

Elective surgery is an important part of a hospital's workload. Whenever a case is put on list, it involves interaction of a number of people and in the same way its postponement affects many parties. The purpose of this study was to highlight the causes of such postponements, their impact on the hospital and to devise an approach to avoid preventable causes. This study was conducted in two operation theatres of Mayo Hospital Lahore over a period of one year i.e. from April 2009 to May 2010. All the patients scheduled to undergo elective surgical procedures in these operation theatres were included. Total number of cases, number of cancellations as well as causes of cancellation were noted. A total 0/252 lists were planned in both theaters and 2394 patients were put on list. Among this total number the operations 0/179 patients [7.47%] were postponed. The highest proportion of postponements was due to time constraints [35.75%]. Other main reasons were patients with uncontrolled blood pressure and cardiac problems [15.08%], treatment of blast victims [11.17%], strikes of the staff [8.37%] and non-availability of ICU bed / ventilator inaddition [5.58%] there were other less common causes as well. As a large proportion of postponements was due to mismanagement of the list time, it was therefore clear that there was lack of proper list planning and unrealistic time allotment for cases. This led to a large number of cancellations at the end of the day. This can be easily prevented by keeping in mind a rough time span taken by each procedure and calculating the total number of cases possible on each table

Comparison of propacetamol with pethidine for postoperative pain relief

The purpose of this study was to evaluate the analgesic effect of a single bolus I.V dose of propacetamol given before induction of anaesthesia and compare this effect with that of I.V pethidine also given before induction. Another objective was to study the opioid sparing effect of cetamol by using in combination with pethidine, after surgical incision had been made. Sixty adult patients of ASA I or II status were included and divided into three groups. Group A received propacetamol 2gm intravenously just before induction, in group B IV bolus dose of pethidine 0.75 mg/kg was given just before induction and group C received combination of pethidine 0.4mg/kg and propacetamol 2gm intravenously 10 minutes after the incision. After awakening from anaesthesia patients were observed for sixty minutes in recovery for pain assessment by the pain scales and the pain scores by VAS and NRS were analysed statistically by using student's t test and Mann-Whitney test. Pain scores by verbal response scale were analysed by Chi square test. p<0.05 was considered significant. No statistical difference was seen among the groups regarding their post-operative pain scores [p-VAS>0.3, NRS>0.2]. The patients who received combination of pethidine and propacetamol required longer time [p<0.05] for supplementary analgesia than the patients who were given propacetamol alone. Propacetamol 2 gm given IV before induction had no advantage over pethidine. Significant benefit of pre-emptive analgesia was not evident in first 60 min after recovery from anaesthesia