Postoperative analgesia; comparison of caudal bupivacaine and bupivacaine - tramadol in children with inguinal hernia repair

To compare the effects after caudal bupivacaine alone and bupivacaine-tramadol in young children with inguinal hernia repair. Department of Paediatric Anaesthesia, Children Hospital Complex, Multan. August 2008 to May 2009. A total of 100 children aged between 2-5 years were included in the study. The duration of analgesia was significantly prolonged in group-A patients [P= 0.001]. A low frequency of postoperative vomiting was observed in both groups i.e. 10% in group-A and 6.7% in group-B [P=0.64]. No respiratory depression, flushing and pruritis were observed. Low dose combination of bypivacaine and tramadol, when administered caudally, had an additive effect and provided prolonged and effective postoperative analgesia with minimal side effects

Analgesic efficacy of single shot caudal block for circumcision

To assess the usefulness of caudal epidural block with bupivacaine for postoperative analgesia after circumcision in children at Children Hospital complex Multan. This study was earned out in Children Hospital Complex Multan from March 2008 to December 2008. One hundred boys, aged 2 to 10 years, ASA 1 status scheduled for elective circumcision. They received caudal epidural block with bupivacaine 0.25%, 0.5ml.kg-1, after induction of general anesthesia and studied for postoperative pain relief. Patients were excluded if they had local infection, preexisting neurological disease, bleeding diathesis or any analgesic ingestion in the preceding week.. Post-operative pain was assessed by Facial expression scale in small children. In older children pain assessment was done by clinical observation, by asking about pain and by dynamic pain score. Mean duration of analgesia was 10.43 +/- 3.4 hours. Time for micturition was 161.79 +/- 83.2 minutes while time to stand was 161.21 +/- 69.65 minutes. Hemodynamic and respiratory parameters remained stable during the observation period. Frequency of postoperative nausea and vomiting was 12% while urinary retention occurred in 2% patients. Caudal epidural block with bupivacaine 0.25% in a dose of 0.5 ml/kg-provides safe and effective postoperative pain relief in children undergoing circumcision and penile surgery, with very few complications

comparison of pressor respons following laryngeai mask airway vs laryngoscopy and endotracheal tube inserition

To test the hypothesis that laryngeal mask airway [LMA] insertion is associated with less pressor response as Compared to endotracheal intubation. A prospective, comparative study. Department of Anaesthesiology Intensive Care and Path Management, Nishtar Medical Institution Multan [Pakistan] from July 2007 to January 2008. 60 adult, ASA grades land II patients undergoing elective general surgery of less than one hour duration were divided in two groups with 30 patients in each. These patients were operated under general anaesthesia and either endotracheal tube [Group I] or LMA [Group II] was used to maintain the airway. The rise in heart rate, systolic and diastolic blood pressure was recorded before induction of anaesthesia and at one, three, five and ten minutes after insertion of laryngeal mask airway or tracheal tube and the results compared in both groups. A statistically significant rise in heart rate, systolic blood pressure and diastolic blood pressure was seen in group-I while statistically significant rise in heart rate only was seen in group-II subsequent to their insertion. Mean maximum increase was statistically more after laryngoscopy and endotracheal intubation than after laryngeal mask airway insertion. The duration of pressor responses was also longer after endotracheal intubation. Laryngeal mask airway is an acceptable alternative techinque offering advantages in terms of haemodynamic stability compared to tracheal intubation

Comparison of 0.5% lignocaine vs 0.5% lignocaine plus 0.25% tramadol in intravenous regional anaesthesia

To compare the quality, onset and duration of intravenous regional anaesthesia [IVRA] with 0.5% lignocaine plus tramadol and 0.5% lignocaine alone. A comparative, double blind, randomized, prospective study. Orthopaedic operating rooms, Nishtar Medical Institution, Multan, Pakistan, from June 2005 to June 2006. In our of 60 adult ASA class I and II patients undergoing upper limb surgeries in patients were divided in two groups having 30 patients in each. We used tramadol, a weak opioid as a component of IVRA with lignocaine to suppress intra-operative pain and enhance postoperative analgesia. Patients received IVRA with 40ml of 0.5% lignocaine to which either 100mg tramadol or saline was added. The onset of anaesthesia and recovery was compared by loss and regain of sensations. Tramadol with lignocaine was found to be significantly better for rapid onset and quality of anaesthesia compared to lignocaine alone and devoid of opioid related side effects. We conclude that tramadol as a component of IVRA is significantly better adjunct to lignocaine

PONV-A comparative study of meto-clopramide alone and with dexamethasone in strabismus surgery

To determine the efficacy of intravenous metoclopramide alone and in combination with dexamethasone in preventing postoperative nausea and vomiting [PONV] in patients undergoing strabismus surgery. Single blinded, randomized, interventional study. This study was conducted in the department of Anaesthesiology at Nishtar Hospital, Multan from October 2005 to October 2006. After the approval of the hospital's ethical committee, the study was conducted on 60 patients who were randomly divided into two groups, each group containing 30 patients. All of the patients were between 2-14 years of age and were A.S.A-I. Randomization was done by envelope draw method. The patients received either metoclopramide 150 micro g/kg or dexamethasone 150 micro g/kg with metoclopramide 150 micro g/kg combination IV, 30 minutes before the induction of anesthesia. General anesthesia was induced with thiopentone sodium, nalbuphine, succinylcholine and maintained with isoflurane and N[2]O+O[2] in both groups. PONV were evulated postoperatively. Patients in group II who received metoclopramide plus dexamethasone experienced significantly less PONV during the first 24 h after surgery. In this study, a single dose of metoclopramide plus dexamethasone [150 micro g/kg of each drug] produced better antiemetic effects after strabismus surgery than metoclopramide alone