Comparison of transversus abdominis plane block versus local infiltration of wound with bupivacine after appendisectomy

Objective: To compare the effect of transverses abdominis plane block verses local infiltration of wound with Bupivacaine to assess frequency of analgesic requirement for pain relieve during 15 hours after appendisectomy. Study Design: Randomized controlled trial. Place and Duration of Study: Combined Military Hospital Peshawar, from Apr 2016 to Oct 2016

Results: Both the groups were comparable with to assess frequency of analgesic for pain relieve after TAP Block Vs local infiltration with bupivacaine. In group A the frequency of analgesic requirement was less as compared to group B [p<0.05]

Material and Methods: Ninety two patients fulfilling the inclusion criteria were included by consecutive sampling technique for this study and divided into two groups of 46 each. Patients of group A were administered transverse abdominis plane [TAP] block via ultrasound guide. Patients in group B received local infiltration with Bupivacaine. Frequency of analgesic requirement for pain relieve were assessed by anaesthetist during 15 hours after appendisectomy

Conclusion: Frequency of analgesic requirement was less in TAP block as compared to local infiltration of wound with bupivacaine during 15 hours after appendisectomy

Malaria; assessment of haematological changes

To see the effects of malaria infection on platelet count and haemoglobin in children suffering from malaria. Descriptive study. CMH Okara and CMH Pano Aqil Cantt. July 2008 to June 2012. Children admitted with fever of less than seven days duration who had positive smear for malaria parasite were included in the study. After detailed history and thorough examination, patients were investigated to find out the cause of fever. All the patients with localizing cause for fever and history of drug intake were excluded. All patients were investigated with complete blood counts and serial peripheral smears for malaria parasite. Peripheral blood smear examination for malarial parasite was taken as gold standard for the diagnosis of malaria. Cut off 9 value for low hemoglobin [anemia] was taken as 10gm/dl and platelet count of less than 150x10[9]/L, was used to define thrombocytopenia. Patients with thrombocytopenia were divided in to three categories. Mild thrombocytopenia was defined as patients with platelet count of <50x10[9]/L to >150x10[9]/L, moderate thrombocytopenia included patients with platelet counts of <20x10[9]/L to >50x10[9]/L and severe thrombocytopenia consisted of patients with platelet counts of <20x10[9]/L. A total of one hundred and fourteen smear positive patients were analyzed, out of which 93% had low and 7% had normal platelet count. 95% had Vivax and only 5% had Falciparum malaria. Mean platelet count was 87x10[9]/L. Mean platelet count in Falciparum was 42x10[9]/L whereas it was 88 x10[9]/L in Vivax malaria. Sixty two [54%] patients had anaemia. Mean haemoglobin was 9.54gm/dl. Mean Hb in Falciparum malaria was 7.5gm/dl and in Vivax it was 9.6gm/dl. Higher frequency of mild to moderate thrombocytopenia and anaemia was observed in hospitalized children suffering from malaria. Plasmodium Vivax was found to be the most common species

Analysis of causes and treatment modality in non-union of long bones diaphyseal fractures

The purpose of this study was to analyze the causes of nonunion leading to modification in treatment modalities in long bones diaphyseal fractures. Descriptive Study. Combined Military Hospital Quetta, Combined Military Hospital Sialkot, Pakistan, from 5th Sep 2005 to 26th Dec 2008. Non-healing long bones diaphyseal fractures > 6 months were included with exclusion of pathological fractures, delayed union < 6 months. Patients general profile and fracture details with non-union causes were recorded. Old failed surgery with re-do surgical intervention was analyzed. Infected cases were treated with removal of implant, thorough debridment, appropriate antibiotics followed by delayed stabilization while non-infected cases with stable fixation and bone grafting. Out of fifty six patients, tibial fractures were maximum 17[30.4%], femur 16[28.6%], radius ulna 15[26.6%], and humerus 8[14.3%]. Most patients were young 37[66.07%] and male 48[85.7%]. Road traffic accident caused 43[76.8%] fractures. Causes of non-union were high energy trauma 37[66%], insufficient stabilization 31[55.4%], followed by smoking, soft tissue interposition, poor nutrition, NSAIDs, broken implants, infection, intact fellow bone, multiple segment fracture, repeated manipulation, chronic illness and neurovascular impairment in descending order. Plates failed more than K nails. Complications like superficial and deep infection, neuroprexia and delayed healing settled with bone healing in mean time 4.76 months. Nonunion of long bones diaphyseal fractures can be prevented by avoiding causative agents, early intervention, tissue protection and stable fixation. Interlock nailing is best for femur, good for tibia, may be useful in humerus but not suitable for radius and ulna. Bone graft accelerates healing process. Early re do surgery must be considered because of manageable rate of complications

Peri-operative Pulmonary Edema a manifestation of Peripartum Cardiomyopathy

A 20 years primigravida presented in emergency with history of pulmonary edema after caesarean hysterectomy under spinal anesthesia, complicated by cardiac arrest. On examination, the patient was conscious, anxious and restless, pale, cyanosed, had edema face and feet, distended neck veins and was orthopnoeic. X-ray chest showed diffuse homogenous opacities in both lung fields. A provisional diagnosis of over transfusion pulmonary edema was made. She was placed on ventilatory support on synchronized intermittent mandatory ventilation [SIMV] along with positive end expiratory pressure [PEEP]. Her endotracheal suction had to be performed quite frequently due to exuberant amount of edema fluid. She was given diuretics, antibiotics and analgesics

Fat embolism syndrome: a case report

A young motorcyclist, who had met a road traffic accident resulting in multiple fractures, later developed fat embolism syndrome. He had to be instituted mechanical ventilation for hypoxemia and deteriorating levels of consciousness and was rendered vigorous management for his critical general condition

Long term home ventilatory support in a patient of motor neuron disease [MND]- a case report

A 45 years old male patient was diagnosed as a case of motor neuron disease. Within four years he became paralyzed and bed ridden. Due to severe respiratory tract infection, the patient developed respiratory failure and was put on ventilator. Later on the infection was successfully treated but the patient could not be weaned from the ventilator because of the paralysis of respiratory muscles. It was obvious that the patient would require life long ventilatory support so the same was arranged at the patient's home and he was discharged from the hospital after nine months. Now, for the past six years the patient is on ventilatory support

comparison of analgesic efficacy of ketorolac and piroxicam for postoperative pain relief after cholecystectomy

A Randomized Control Trials [RCT] single blinded study was designed to evaluate the analgesic efficacy of ketorolac and compare its effectiveness with the analgesic efficacy of piroxicam for postoperative pain management after cholecystectomy at Department of Anaesthesiology and intensive care, PNS Shifa Hospital, Karachi. In this study, fifty patients who had to undergo cholecystectomy were randomized in two groups. The patients were followed for 72 hours post operatively. All the patients were operated through a standard subcostal incision [3 to 4 inches in length]. The patients were American Society of Anaesthesiology status [ASA] of I, II, of both the sexes, aged between 30 to 60 years. A balanced anaesthetic technique was used for all the patients during the conduct of procedure. First dose of both the drugs was given immediately after induction [30 mg Ketorolac I/V and 20 mg Piroxicam I/M]. Postoperatively, group I patients received injection Ketorolac 30mg I/V 8 hourly, group II patients were given injection Piroxicam 20 mg I/M once daily. If pain persistently remained above 5 on visual analogue scale [VAS], injection Pethidine 50 mg I/V p.r.n. was used as rescue analgesia for both the groups.. In group I [ketorolac group] only 5 patients [20%] required rescue analgesia whereas in group II eight patients [32%] required it. The effect of both the drugs on pulse rate, blood pressure, respiratory rate and oxygen saturation were monitored and recorded. The frequency of postoperative complication was recorded. Relevant laboratory data [bleeding time, platelets count, serum urea and electrolytes and liver function tests] was monitored. Both the drugs were found effective in controlling postoperative pain. Both drugs Ketorolac and Piroxicam provided adequate pain relief

comparison of analgesic efficacy of ketorolac and piroxicam for postoperative pain relief after cholecystectomy

Objective: This prospective randomized single blind study was designed to evaluate the analgesic efficacy of ketorolac and compare its effectiveness with the analgesic efficacy of piroxicam for postoperative pain management after cholecystectomy

Settings: Department of Anaesthesiology and Intensive Care, PNS SHIFA, KARACHI

Methodology: In this study, fifty patients who had to undergo cholecystectomy were randomized in two groups. The patients were monitored for 72 hours post operatively. The patients were ASA physical status of I and II, of both the sexes and aged between 30 to 60 years. A balanced anaesthetic technique was used for all the patients during the conduct of procedure. All the patients were operated through a standard subcostal incision [3 to 4 inches in length]. First dose of both the drugs was given immediately after induction [15 mg Ketorolac I/V or 20 mg Piroxicam I/M]. Postoperatively, group I patients received injection Ketorolac 15mg I/V8 hourly, group II patients were given injection Piroxicam 20mg I/M once daily. If pain persistently remained above 5 on VAS, injection Pethidine 50mg I/V p.m. was used as rescue analgesia for both the groups. In group I [ketorolac group] 7 patients [28%] required rescue analgesia whereas in group II, eight patients [32%] required it. The effect of both the drugs on pulse rate, blood pressure, and respiratory rate and oxygen saturation were monitored and recorded. The frequency of postoperative complications was recorded. Relevant laboratory data [bleeding time, platelet count, serum creatinine and liver function tests] was monitored

Results: Both the drugs were found effective in controlling post operative pain. Ketorolac was found to be as effective an analgesic as piroxicam. Both drugs had similar side-effects spectrum

Conclusion: Both drugs Ketorolac and Piroxicam provided adequate pain relief

Awareness during anaesthesia: a review

Awareness during anaesthesia refers to a patient experiencing an intra operative event. True incidence of intra operative awareness is poorly documented but varies according to type and depth to anaesthetic technique. About 1% to 2% of patients experience awareness while under general anaesthesia, mostly during induction can occur without conscious awareness. Inability to recall intra perception can occur without conscious awareness. Inability to recall intra operative events does not preclude awareness of those events. Patients who experience awareness later report feeling of sever anxiety, panic, fear and dread of imminent death. By virtue of its nonphysical nature, awareness is not easily recognizable or quantifiable. The occurrence of awareness can be minimized by the addition of a benzodiazepine like midazolam or an inhalational agent to anaesthetics. In 1845, William Morton used diethyl ether or anesthetize a patient who later reported that he had been aware of the surgery but had felt no pain1. Since then, a continuous flow of case surveys, reports, and controlled studies have described the occurrence of awareness of awareness under anaesthesia, Nevertheless, after more than 150 years, anaesthetists still have no reliable means of monitoring the depth ofanaesthesia to determine whether a patient is conscious during surgery