ABSTRACT
To compare post operative pain in patients undergoing TAP block with that of standard post operative care in patients undergoing abdominal surgery. Fifty patients [21 males, 29 females] with ASA class I and II undergoing abdominal surgery were included in the study. Half of the patients selected through randomization received TAP block using landmark technique at the end of surgery under anaesthesia. The remaining half received standard post operative analgesia with nalbuphine and diclofenac sodium injections. All patients were questioned regarding the degree of analgesia on a Pakistan Coin Pain Scale till 12 hours post operatively. Use of analgesics was compared in the two groups postoperatively. The degree of pain was significantly lower in patients receiving TAP block compared with standard postoperative care [mean score 06 vs 16 p<0.05]. The quantity of nalbuphine [0.32 vs 4.08 p<0.01] and diclofenac sodium [9.0 vs 63 p<0.01] were significantly reduced in patients receiving TAP block compared with standard post operative care. Transversus abdominis plane block provides effective post operative analgesia and is associated with markedly reduced analgesic consumption
ABSTRACT
Objectives: to compare the time of onset, adequacy of surgical analgesia and motor blockade with epidural anaesthesia versus spinal anaesthesia for hysterectomy. To compare the frequency of hypotension and need for switching to general anaesthesia with spinal versus epidural anaesthesia for hysterectomy
Material and Methods: one hundred patients with ASA I or II undergoing hysterectomy were included in the study. Fifty patients underwent surgical procedure under epidural [E] and fifty under spinal [S] anaesthesia. Both groups were monitored for onset and quality of surgical analgesia, degree of motor blockade, frequency of hypotension and need for conversion to general anaesthesia
Results: the time of onset of surgical analgesia was significantly shorter in spinal group compared with epidural group [9.12+2.56 vs 21.7+3.59 minutes, p<0.001]. The quality of surgical analgesia was not significantly different in both groups. The degree of motor blockage was significantly more pronounced in the spinal group [mean modified Broomage scores 1.08 vs 2.10 p<0.01]. The frequency of hypotension was more in the spinal group [8 vs. 2 patients p<0.05]. The need to convert to general anaesthesia was more common in spinal compared to epidural group [8 vs. 1 patient p<0.05]
Conclusion: spinal anaesthesia for hysterectomy is associated with quicker onset of action, better motor blockade. However, both techniques allow adequate level of surgical analgesia which is not significantly different with spinal or epidural anaesthesia. Frequency of hypotension and need for conversion to general anaesthesia is more common with spinal compared with epidural anaesthesia for hysterectomy
ABSTRACT
This pilot study was designed to judge the Prophylactic role of epidural injection for prevention of post dural puncture headache [PDPH] in patients with accidental dural puncture during the setting up of epidural anaesthesia. Ten patients who sustained accidental dural puncture during routine epidural anaesthesia for various gynaecological and obstetrical surgical procedures carried out in [Iynae Block of Services Hospital Lahore between 16-03-05 to 15-04-06 were included in the study. All patients had ASA I to ASA III status. The age range was 25 to 50 years and weight range was 45 to 70. Kg. A 16 gauge Touhy needle was used for epidural anaesthesia. In case of dural puncture, epidural anaesthesia was given one space above or below the site of puncture. The study was approved by hospital ethical committee. After completion of surgery, 30 ml of normal saline [0.9%] was injected in the epidural space. All patients were observed for three days for occurrence of post dural puncture headache. Two out of ten patients [20%] complained of post dural puncture headache. One patient had to undergo repeat surgery under general anaesthesia for a surgical complication but did not complain of post dural puncture headache. Prophylactic epidural saline injection is associated with low frequency of post dural puncture headache in patients with accidental dural puncture during setting up of epidural anaesthesia