Post operative nausea and vomiting [ponv]: comparison of timing of administration of antiemetics in prolong surgeries

The objective of this study was to compare the timing of administration of Ondansetron and Dexamethasone in terms of prevention of postoperative nausea and vomiting when given at induction verses thirty minutes before the end of prolong surgeries. Randomized control trial. The study was conducted in Main Operation Theatre of Combined Military Hospital Rawalpindi over a period of six months from 17 Apr 2009 to 16 Oct 2009. Cases were selected from OPDs, emergency and also by referral. Total 120 patients were included in this study [60 patients in each group] Group A patients received Ondansetron 4 milligrams and Dexamethasone 8 milligrams intravenous at induction and group B patients received Ondansetron 4 milligrams and Dexamethasone 8 milligrams thirty minutes before reversal of neuromuscular blockade at the end of surgery. Mean age was observed 41.7 +/- 3.7 and 39.9 +/- 1.9 in group-A and B, respectively. Comparison of pre-induction and 30 minutes before end of surgery at 0-6 hours reveal nausea and vomiting in 11 [18.3%] in group-A and in 3 [5.0%] patients of group-B. Results were statistically significant [p=0.022]. At 7-12 hours results were also statistically significant when comparison was made between group-A and B [p=0.051], while at 13-24 hours difference between two groups was statistically non-significant [p=0.314]. It is therefore established that administering a combination of Inj. Ondansetron 4mg with Inj. Dexamethasone 8mg, was more efficacious in reducing post-operative nausea and vomiting at 0-6 hours when administered 30 minutes before the completion of surgery

Intravenous regional anesthesia [bier's block]; to compare the analgesic effects of combination of 0.5% lidocaine plus ketrolac in intravenous regional anesthesia technique with those of lidocaine 0.5% alone to prevent post operative pain

To compare the analgesic effects of combination of 0.5% Lidocaine plus Ketorolac in intravenous regional anaesthesia technique with those of Lidocaine [0.5%] alone to prevent post operative pain after intravenous regional anaesthesia [Biers block]. Randomized Control Trial. The study was carried out at Department of Anaesthesiology, Intensive Care and pain management, Combined Military hospital, Rawalpindi from July 2008 to February 2009. The study was conducted after complete evaluation of risk / benefit ratio to the patients. On the basis of random number method the patients were divided into two equal groups [group A and group B]. The number of patients in each group was 75. Group A was assigned Lidocaine in a dose of 200mg 40ml of 0.5% solution and group B was assigned injection Ketorolac 30mg added to Lidocaine in a dose of 200mg 40ml of 0.5% solution. The patients were kept in post anaesthesia care unit for two hours and pain intensity was measured by visual analogue scale[VAS] on 15,30 minutes,1hour, 1.5 and at 2 hours after the cuff deflation. The analgesic efficacy recorded on the basis of visual analog scale of two groups, was compared using student's t - test. p value of less than 0.05 was considered statistically significant. In group A 33 males and 42 females were enrolled for the study while in group B there were 38 males and 37 females. The mean age of the patients in group A was 34.31 +/- 6.03 years while in group B was 32.99 +/- 6.08 years. Patients were also classified according to ASA classification in which 87 patients were classified as ASA - I and 63 patients as ASA - II. Group B which received Ketorolac in addition to Lidocaine for Bier's block had low visual analogue scores as compared to group A which received only Lidocaine for Bier's block. P values obtained after the comparison of the mean VAS of two groups at 15 minutes, 30 minutes, 1 hour, 1.5 hours and 2 hours were all less than 0.05 [0.002 for 15 minutes, 0.004 for 30 minutes, 0.001 for 1 hour, 0.004 for 1.5 hours and 0.001 for 2 hours]. Ketorolac improves the postoperative analgesia markedly when used with Lidocaine in intravenous regional anaesthesia

Oxytocin IV bolus vs infusion; haemodynamic effects in women undergoing caesarean section

Obstetric texts advocate the use of oxytocin, either intramuscularly or as a dilute infusion, but warn against the use of intravenous bolus oxytocin, fearing significant maternal hemodynamic consequences. To compare the hemodynamic effects of oxytocin given intravenous bolus versus infusion form. Randomized clinical trial. Study was conducted in main operation theatre and OPD of Combined Military Hospital, Rawalpindi. Study was carried out over a period of six months from 24-03-2009 to 23-09-2009. Total 138 patients were included in this study. Patients were divided into two groups [Group-A received oxytocin as bolus of 5 iu given as quickly as possible [approximately over 1 s] and in group-B 5 iu diluted to 20ml normal saline given over 5 minute using an infusion pump]. Each group comprised of 69 patients. Mean age of the patients in group-A was 27.3 +/- 1.8 and in group-B, 26.9 +/- 1.7. Heart rate [beast/min] effect of oxytocin given intravenous bolus vs infusion showed statistically significant difference from 1 minute to 15 minute [P<0.001]. Similarly mean arterial pressure [MAP] rate [beast/min] effect of oxytocin given intravenous bolus vs infusion also showed statistically significant difference from 1 minute to 15 minute [P<0.001]. In conclusion, we found that at elective Caesarean section, 5 iu of i.v. oxytocin results in less haemodynamic change than 5 iu diluted to 20ml normal saline given over 5 min using as an infusion pump results in less haemodynamic change than 5 iu of oxytocin given as i.v. bolus