ABSTRACT
Background: In the earlier periods analgesia was restricted to surgical and immediate postoperative period. However, this was associated with a lot of morbidities to the patient in terms of surgical stress and increased requirements for analgesia as the pain persisted. Patient’s attitude and concern about postoperative pain need to be addressed preoperatively. Early interventions are essential for better long-term outcomes. Because of the multiplicity of mechanisms involved in postoperative pain, a multimodal analgesia regimen, with a combination of opioid and non-opioid analgesic drugs is often used to enhance analgesic efficacy, reduce opioid requirements and its side effects. Aim of the study: To compare the efficacy of ketorolac in the management of postoperative pain when administered intravenously or intramuscularly, to assess the efficacy of ketorolac by two routes of administration namely Intravenous (IV) and Intramuscular (IM). Materials and methods: This comparative study was done in 2015 in Pondicherry Institute of Medical Sciences, Pondicherry. Totally 60 patients undergoing elective surgeries under ASA I/II was selected and they were divided into two groups of 30 patients each. Postoperatively the patients were examined at half hourly intervals for the first 6 hours for pain and it was graded using Visual Analogue Scale (VAS). If VAS score was > 3, inj. Tramadol 1mg/kg IV was given as rescue analgesic and the time was noted. Any adverse effect such as dizziness, vomiting, nausea was also Maria Varun Raj, R. Ahila, Sangiev Koshy George. Comparative study on efficacy of Ketorolac in the management of postoperative pain when administered intravenously or intramuscularly. IAIM, 2019; 6(3): 164-169. Page 165 noted at half hourly interval for the first six hours following surgery. Total dosage and frequency of rescue analgesic tramadol in the 24 hour period were also calculated. Use of anti-emetics was noted. Results: Postoperative VAS score between the two groups was comparable at zero hours and after the first hour. However, at the 4th and 5th hour, there was a statistically significant difference in the scores between the two groups showing a better analgesic effect with the intramuscular route of administration of ketorolac. The mean VAS score at the end of the 5 th hour showed a statistical difference between the two groups (p=0.001). Postoperative VAS score between the two groups was comparable. However, at the 4th and 5th hour, there was a statistically significant difference in the score between the two groups. The mean duration of analgesia produced by intramuscular routes was found to be high when compared with that of the intravenous route and is statistically significant (p=0.001). The mean duration of analgesia produced by intramuscular routes was found to be high when compared with that of the intravenous route and is statistically significant. (p=0.001). Conclusion: We conclude that ketorolac can be used for postoperative analgesia in place of opioids in patients where opioid has to be avoided. Intramuscular administration provided more effective and prolonged pain relief when compared to intravenous administration.
ABSTRACT
Background: Type2 diabetes mellitus (T2DM) is a highly inheritable disease. Transcription factor 7- like 2 (TCF7L2) gene regulates the expression of glucagon-like peptide 1 (GLP-1) in L cells of small intestine. GLP1 plays a critical role in blood glucose homeostasis by stimulating postprandial insulin secretion and increasing insulin sensitivity. Aim of the study: TCF7L2 gene variants may affect the susceptibility to Type 2 diabetes by altering GLP-1 levels. Materials and methods: This case-control study was conducted with 90 newly diagnosed patients with Type2 diabetes mellitus as cases and 90 age and sex-matched healthy volunteers as controls. TCF7L2 rs7903146 genotyping was done and we also estimated Fasting and postprandial GLP -1 level, Fasting and Postprandial insulin level and calculated HOMA-IR in both cases and controls. Results: Out study showed that T+ genotype, lower fasting GLP-1 level and lower postprandial GLP1 levels were more observed among cases as compared to controls. Low mean GLP 1 activity, high Mean HOMA-IR, low postprandial insulin, low percentage rise in insulin were observed among T+ genotype than among T- genotypic individuals. Conclusion: Hence, the study concludes that T+ genotype causes a decrease in GLP-1 levels, which in turn by decreasing postprandial insulin levels and by increasing insulin resistance increases the risk of Type2 diabetes.