ABSTRACT
Background and Objectives: Abdominal hernioplasty is a very common intervention that can be performed under general or spinal anesthesia. We compared general and spinal anesthesia in patients undergoing open abdominal hernia repair on elective basis
Study Design: Randomized control study
Place of Study: Allied Hospital Faisalabad
Period: September 2017 to December 2017
Methodology: Forty [40] adults received either General Anesthesia with succinylcholine, propofol, nelbuphine and atrarcurium [group A, n=20] or spinal anesthesia [L3-L4] with bupivacaine 0.5% 10mg [group B, n=20]. Then the Hemodynamic data [blood pressure, pulse], pain scores, time to first analgesic and side-effects were recorded of the patients
Results: Among the patients, hernia was supraumbilical in 6, umbilical in 7 and infraumbilical in 7 patients of group A and in 6, 6 and 8 in group B patients, respectively, p value >0.05. Maximum decrease of systolic blood pressure was 10+/-6 in group A and 21+/-6% in group B, p value <0.05 and of heart rate 11+/-5 and 17+/-7%, p value >0.05, respectively. Pain scores at 0, 2, 4 and 8 hours after surgery were: 4 [2-6], 5 [2-7], 5 [1-6] and 4 [2-6] in group A and 0, 0, 0 [0-2] and 1 [0-3] in group B, respectively, p value <0.05. Pain scores at 12 and 24 hours were 4 [1-5] and 3 [0-4] in group A and 2 [0-4] and 1 [0-3] in group B, respectively, p value >0.05. Time to first analgesic was 28+/-10 in group A and 580+/-138 min in group B, p value <0.001. 7 [35%] of the patients in group A and 1 [5%] in group B patients had post-operative nausea and vomiting, p value <0.05
Conclusion: Patients undergoing open ventral hernia repair and received general anesthesia were more stable in terms of blood pressure and heart rate but the patients who received spinal anesthesia had less postoperative pain and less post-operative nausea and vomiting
ABSTRACT
Diabetes mellitus [D.M] is one of the main problems in health systems and a global public health threat that has increased dramatically over the past 2 decades. Patients with D.M are prone to multiple complications such as diabetic foot ulcer [DFU]. Despite of the advantages of debridement, adequate debridement must always precede the application of topical wound healing agents, dressings or wound closure techniques
Objective: The objective of the study was to compare the efficacy of adjuvant topical oxygen therapy with conventional methods and conventional methods alone in management of infected diabetic wounds
Study Design: Randomized Control Trial
Setting: Surgical Unit III, Allied Hospital, Faisalabad
Period: 4 months from March to June 2017
Methodology: A total of 120 cases included in this study were admitted either through OPD or emergency ward. Group A [Topical oxygen therapy was given along with conventional methods]. Group B [Only conventional methods of wound care were applied]. All patients were given single dose IV antibiotic half an hour before induction of anesthesia. All diabetic patients were administered regular insulin to control blood glucose levels. Good debridement was done, removing all dead tissue. Simple available cellophane bag applied, sterilized with antiseptic solution, tailored according to size of affected part used tapped on open side of body of patient like tourniquet. 100% oxygen was given in bag with routinely available oxygen cylinder exposing whole affected part of body or limb. Oxygen in chamber was given for maximum one and a half hour twice daily in one sitting for 7-10 days. Gram positive, gram negative and anaerobic cover was given with antibiotics. Wound was washed daily with normal saline. After clinical improvement patient was discharged and called for follow up at outdoor on weekly basis initially and then fortnightly for 6 months
Results: Mean age was calculated as 49.56+/-7.02 and 49.11+/-6.59years in group A and B respectively. 53.33% [n=32] in group A and 58.33% [n=35] in group B were males, while 46.67% [n=28] in group A and 41.67% [n=25] in group B were females. Comparison shows that 46.67% [n=28] in group A and 26.67% [n=16] in group B had efficacy; p value was calculated as 0.02 showing a significant difference
Conclusion: Efficacy of adjuvant topical oxygen therapy with conventional methods is significantly higher when compared with conventional methods alone in management of infected diabetic wounds