Caudal analgesia in children; comparison between bupivacaine and bupivacaine plus tramadol

Caudal analgesia with bupivacaine is used commonly for pain relief in children and extradural administration of tramadol seems to be a safe method of analgesia. The aim of the study was to compare the analgesic efficacy of caudal bupivacaine and bupivacaine and tramadol mixture for postoperative analgesia and to observe for the side effects. Department of Anesthesia and Intensive Care Unit, Bahawal Victoria Hospital, Bahawalpur. 01-12-2010 to 30-11-2011. Eighty children, aged between 2 to 12 years of age undergoing infra umbilical surgeries were selected for this randomized, controlled trial. They were randomly divided into two groups A and B. Group A [n = 40] received 0.5 ml/kg of 0.25% bupivacaine and Group B [n = 40] received 0.5 ml/kg of 0.25% bupivacaine with 1 mg/kg of tramadol as a single shot caudal block. In the postoperative period, duration of analgesia, pain score, nausea, vomiting and side effects were noted and analyzed. Patients in both groups were comparable for age and weight. It was observed that the mean duration of analgesia in group A patients was 6.23+0.68 hours while in group B, it was 9.33+0.72 hours [p<0.05]. Nausea and vomiting was present in 20% [n=8] patients in group A, while in group B, 27.5% [n=11] had nausea and vomiting in the post operative period [p<0.05]. None of the patients in both the groups had complications like motor weakness, urinary retention in the postoperative period. The addition of tramadol to bupivacaine in the caudal analgesic technique provides longer analgesia and lesser need for rescue analgesia in the postoperative period compared to bupivacaine alone

Primary postpartum hemorrhage; efficacy of oral misoprostol in comparison to intravenous oxytocin

It is to compare efficacy of Oral Misoprostol with intravenous oxytocin in the management of primary post partum hemorrhage. Quasi experimental study. Obstetrics and Gynaecology Unit-I, Bahawal Victoria Hospital, Bahawalpur. From 1st December, 2006 to 1st December, 2007. The study was conducted on 90 patients who went into post partum hemorrhage during the study period. Cases were divided into two groups each having 45 patients fulfilling the inclusion criteria. Group 'A' had those who received oral misoprostol 600microg and group 'B' those who received 5 UNITS intravenous oxytocin. The variables analyzed were failure of drug, time taken to control bleeding and side effects of drugs. Students t-test was used for comparison between means and chi-square test for comparison between percentages. Significance was taken at P<0.05. It was noted that failure rate of oral misoprostol was 11.1% and that of oxytocin was 22.2%. Mean time taken to control bleeding by misoprostol was 16.6 minutes and 1.311 minutes by intravenous oxytocin. Side effects was observed in 35.5% cases of misoprostol group and 2.22% cases of oxytocin group. The time taken to control bleeding and side effect profile is more better in intravenous oxytocin as compared to oral misoprostol in the menagemnt of primary postpartum hemorrhage, but number of patients responded to oral misoprostol are more, so it can be used as in combination of oxytocin where oxytocin alone failed to work

Complications in cases of enteric perforation

Enteric perforation is a disastrous complication of untreated or poorly treated typhoid fever and unless treated by surgical method, it results in considerable morbidity and mortality. The purpose of this study to describe complications of ileostomy in patients of enteric perforation. The study was conducted was in surgical units B-V hospital, Bahawalpur from 1[st] July 2008 to 30[th] June 2009. This was a descriptive case series study. 100 patients of both genders suffering from typhoid fever with perforation who underwent ileostomy were included the study. All the data was collected on pre-designed proforma. Most of the patients were young with male to female ratio 1.6:1. Ileostomy was done in all the patients after cleaning the peritoneal cavity. Ileostomy was associated with diarrhea 20%, peristomal skin problems 22%. Other complications were bleeding in 3%,prolapsed in 5%, retraction in 4%, parastomal hernia in 5%, wound infection in 8%, intestinal obstruction in 5% patients, incisional hernia and psychological symptoms in 2% patients and stoma stenosis in one patient in our study. Two patients expired due the complication of ileostomy. Although ileostomy is not the most favored way of treatment of enteric perforation and it is associated with a number of complications and management problems, it is still a good option and life saving procedure in our setup where patients present very late with gross peritoneal contamination

Risk factors for primary postpartum hemorrhage

To describe the associated risk factor for primary Postpartum Hemorrhage [PPH] and its severity with increasing parity and duration of labour. It was a descriptive study. Place and duration of study: The Department of Obstetrics and Gynecology [Unit II] of Bahawal Victoria Hospital, Bahawalpur from January 2004 to December 2004. Patient and method: Fifty patients with primary postpartum hemorrhage were included in this study. Data was collected from the patients through a structured proforma. The variable studied were parity, duration of labour and risk factors for primary PPH. The results were statistically analyzed, chi-square test was applied to find out the significance of parity and duration of labour and their relationship with severity of PPH. Simple percentages were used to find associated risk factor for primary PPH. The frequency of primary PPH in primary para was 24% [12 patients] and in multi para was 76%[38 patients]. Severity of PPH increased with increasing parity [P<.05]. After merging the variable of parity severity of PPH increased in patients with prolonged labour in normally delivered patients [P<.05]. As for as risk factors are concerned 60% had uterine atony while 16% got cervical tear and the same number had retained placenta, 8% had preneal tear, Uterine inversion was seen in 6%, 4% presented with polyhydrominos, same with placenta previa type-1. 4% had vaginal laceration, 2% had DIC and 2% had abruptio placenta. The result of the study revealed a number of associated risk factors for primary PPH and proved the relationship of its severity with increasing parity and duration of labour. Duration of labour had a significant relationship with PPH even in Primipara