Comparison of postoperative pain relief following use of spinal anesthesia versus general anesthesia for patients undergoing laparoscopic cholecystectomy

Objectives: Effective post-operative pain control is an essential component of care of surgical patients. Various analgesic regimens have been used to ensure adequate postoperative pin relief. We conducted this study to compare the efficacy of spinal anesthesia versus general anesthesia regarding post-operative pain following laparoscopic cholecystectomy

Methodology: After approval of the hospital ethical committee, 120 females were included in our randomized, control trial from 1 July 2015 to 31 Dec 2015. Patients were explained about the study and informed consent was signed by them or their guardians. Patients were randomly divided into two groups; in Group-A patients, spinal anesthesia was achieved with 3 ml 0.5% hyperbaric bupivacaine hydrochloride and 25 microg fentanyl. Group-B was given GA. All the patients were premedicated with IV metoclopramide 10 mg and dexamethasone 8 mg; preemptive analgesia with 0.1 mg/kg nalbuphine was done. Induction of GA was done with propofol 2 mg/kg, muscle relaxation was achieved with atracurium besylate 0.5 mg/kg. Endotracheal intubation with 6.5 or 7 mm cuffed tube was done, Visual analogue scale [VAS] was used to assess pain severity at immediate post-operative period (S-0) and at 6 hours [S-6]. Data was analyzed using SPSS version 16.0. For quantitative variables like pain score and age, mean and standard deviation [SD] were calculated. For qualitative variables like severity of pain, frequency and percentages were calculated. Chi-square test was used to measure frequency of pain between two groups. P-value < 0.05 was taken as significant

Results: The two groups did not differ in demographic profiles. At S-0, the mean score in Group-A was 2.89 +/- 2.49 [mode = 1, median 2] versus 3.83 +/- 2.56 [mode = 3, median = 3], p value 0.0364. At zero hours [S-0]; 6 [10%] patients in Group-A had no pain [VAS less than 2], 28[46.6%] patients had mild pain and 26 [43.3%] patients had severe pain. In Group-B 8[13.3%] had no pain, 20[333%] had mild pain and 32[55%] patients had severe pain. The p value was 0.947, which is statistically insignificant At S-6, the mean VAS was 6.94 [median = 7, mode = 8] in Group-A versus 6.23 +/- 2.11 [median = 6, mode = 5] in Group-B, p value 0.0277. At six hours [S-6], 31[51.6%] patients no mild pain in Group-A, 24[40%] had mild pain and 5[8.3%] had severe pain. Whereas 30 [50%] patients had no pain, 8 [13.3%] patients had mild pain and 22 [36.6%] patients had severe pain in Group-B. The p-value was 0.022, which is statistically significant

Conclusion: Our study has shown that single shot spinal anesthesia provides better postoperative analgesia in the postsurgical period. The addition of intrathecal fentanyl provides adequate analgesia, including relief from shoulder tip pain. So, spinal anesthesia can be safely used as sole anesthesia for laparoscopic cholecystectomy

Squamous cell carcinoma of the breast

Objective: To analyse the epidemiological characteristics, clinical presentations, and histopathological as well as immunological characteristics of squamous cell carcinoma [SCC] of breast. Study Design: A descriptive study. Place and Duration of Study: Combined Military Hospital, Rawalpindi, from January 1997 to January 2017

Methodology: Data of all patients, diagnosed as squamous cell carcinoma of breast over defined period of time, were collected and analysed with respect to their clinical presentation, histopathology and receptor status. Year-wise cases of SCC of breast were separated

Results: Thirty patients, diagnosed as squamous cell carcinoma of breast, were identified over a period of 20 years. There was an increase in number of cases diagnosed after 2007 as compared to before 2007. Moreover, 12 [40%] cases were hormone receptor positive while 18 [60%] were of unknown status. Out of the total, 10 [33%] cases were well differentiated, 17 [57%] were moderately differentiated, while 3 [10%] were poorly differentiated. Seventeen [57%] cases presented as breast masses, 10 [33%] had skin ulceration in addition to breast mass, while 3 [10%] cases presented as fungating masses along with chest wall involvement

Conclusion: There is an increased incidence of SCC of breast which can be due to better diagnostic facilities and more awareness amongst doctors about different varieties of breast cancers and their impact on the prognosis of disease

Squamous cell carcinoma of the breast

Objective: To analyse the epidemiological characteristics, clinical presentations, and histopathological as well as immunological characteristics of squamous cell carcinoma [SCC] of breast

Study Design: A descriptive study

Place and Duration of Study: Combined Military Hospital, Rawalpindi, from January 1997 to January 2017

Methodology: Data of all patients, diagnosed as squamous cell carcinoma of breast over defined period of time, were collected and analysed with respect to their clinical presentation, histopathology and receptor status. Year-wise cases of SCC of breast were separated

Results: Thirty patients, diagnosed as squamous cell carcinoma of breast, were identified over a period of 20 years. There was an increase in number of cases diagnosed after 2007 as compared to before 2007. Moreover, 12 [40%] cases were hormone receptor positive while 18 [60%] were of unknown status. Out of the total, 10 [33%] cases were well differentiated, 17 [57%] were moderately differentiated, while 3 [10%] were poorly differentiated. Seventeen [57%] cases presented as breast masses, 10 [33%] had skin ulceration in addition to breast mass, while 3 [10%] cases presented as fungating masses along with chest wall involvement

Conclusion: There is an increased incidence of SCC of breast which can be due to better diagnostic facilities and more awareness amongst doctors about different varieties of breast cancers and their impact on the prognosis of disease

Comparison of electrosurgical versus scalpel skin incision in inguinal hernioplasty in terms of early postoperative pain

Objective: To compare early mean postoperative pain following use of diathermy and scalpel for making skin incision in inguinal hernioplasty

Study design: Double blind, randomized controlled trial

Place and Duration of study: Department of General surgery, Combined Military Hospital Rawalpindi, from September 2011 to February 2012

Methodology: A total of 60 patients who underwent either diathermy skin incision [group A n=30] or scalpel skin incision [group B n=30] were analyzed. Early postoperative pain was compared in both the groups by using visual analogue scale. The inclusion criteria were all adult male and female patients who underwent elective or emergency inguinal hernioplasty under spinal anesthesia. The exclusion criteria were patients with recurrent inguinal hernias and patients operated under general or local anesthesia

Results: Mean VAS was 2.15 + 1.200 in the diathermy group and p value was 0.00, which was significant.In the scalpel group mean VAS was 4.95 + 1.373. Mean percentage of pain score in scalpel was 49.5%, whereas in diathermy group its was 21.5%, which is significantly lower than the scalpel group

Conclusion: Diathermy incision has significant advantage compared with scalpel in terms of reduced early postoperative pain

Strangulated internal hernia through falciform ligament: a rare cause of small bowel obstruction

Internal hernia through the falciform ligament is exceedingly rare. Preoperative diagnosis is extremely difficult, therefore high index of suspicion is required. We report a case of 72 year old male who presented with discomfort in upper abdomen and episodic bilious vomiting. He later developed severe excruciating abdominal pain with generalized guarding. Exploratory laparotomy revealed strangulated internal hernia through the falciform ligament

Screening of some ethnobotanically important plants of Nagar area Gilgit-Baltistan, Pakistan

Certain species of ethnobotanical importance belonging to families Asteraceae, Berberidaceae, Cupressaceae, Elaeagnaceae, Gentianaceae, Salicaceae and Tamaricaceae, were collected from Gilgit during the months of June and July 2008 and were investigated for the presence of alkaloids, amino acids, anthraquinone [free and as glycosides] ascorbic acid, carbohydrates, coumarins, flavonoids, phenolics, proteins, saponins and steroids in their aqueous, ethanol and benzene extracts. Artemisia maritime L. [leaves] showed positive results for carbohydrates, coumarins, phenolics and proteins. Ephedra gerardiana Wall ex. Stapf. [stem] tested positive for alkaloids, ascorbic acid, coumarins, phenolics, proteins, saponins and steroids. Tamarix gallica L. tested positive for alkaloids, amino acids, anthraquinone as glycoside, ascorbic acid, carbohydrates, flavonoids, phenolics, proteins and steroids in stems, roots and leaves. Salix acmophylla Boiss. showed positive results for alkaloids, amino acids, anthraquinone [free and as glycosides] ascorbic acid, carbohydrates, flavonoids, phenolics, proteins, saponins and natural steroids. Hippophae rhamnoides L. showed positive results for alkaloids, amino acids, anthraquinone [free as glycosides] ascorbic acid, carbohydrates, coumarins, flavonoids, phenolics, proteins, saponins and steroids. Berberis glycocarpa Stapf. showed positive results for alkaloids, amino acids, ascorbic acid, carbohydrates, flavonoids, phenolics, proteins and steroids in stem, roots and leaves. Similarly Juniperus excelsa Wall ex. C.A. Meyer showed positive result for anthraquinone [both free and as glycosides], carbohydrates, phenolics, proteins, saponins and natural steroids

Preliminary phytochemical screening of some plants of ethnobotanical importance from district Gilgit of Northern Areas, Pakistan

Seven medicinal plants of ethnobotanical importance belonging to families Elaeganaceae, Gentianaceae, Cupressaceae, Asleraceae, Tamaricaceae, Berberidaceae and Salicaceae were investigated for the presence of alkaloids, amino acids, anthraquinone [free nad as glycosides] ascorbic acid, carbohydrates, coumarins, flavonoids, phenolics, proteins, saponins and steroids in their coumarins, phenolics and proteins. Ephedra gerardiana [stem] [family ephedraceae] tested positive for alkaloids, ascorbic acid, coumarins, phenolics, proteins, saponins and steroids. Tamarix gallica [Family Tamaricaceae] tested positive for alkaloids, amino acids, anthraquinone as glycoside, ascorbic acid, carbohydrates, flavonoids, phenolics, proteins and steroids in stems, roots and leaves. Salix accomophylla [family Silaceae] showed positive results for alkaloids, amino acids, anthraquinone [free and as glycosides] ascorbic acid, carbohydrates, flavonoids, phenolics, proteins, saponins and steroids. Hippophe rhamnoides [family Elaeganaceae] showed positive results for alkaloids, amino acids, anthraquinone [free and as glycosides] ascorbic acid, carbohydrates, coumarins, flavonoids, phenolics, proteins, saponins and steroids. Berberis aristata [family Berberidaceae] showed positive results for alkaloids, amino acids, ascorbic acid, carbohydrates, flavonoids, phenolics, proteins and steroids in stem, roots and leaves, Juniperus excelsa [Family Juniperaceae] showed positive results for anthraquinone [both free and as glycosides], carbohydrates, phenolics, proteins, saponins and steroids