ABSTRACT
BACKGROUND: Total knee arthroplasty (TKA) causes considerable postoperative pain. This study investigated the analgesic effects of gabapentin on postoperative pain in patients undergoing unilateral TKA in Mongolia. METHODS: The study randomly assigned 95 patients with American Society of Anesthesiologists physical status class 1–3 scheduled for unilateral TKA into two groups. The treatment group (n = 49) was given gabapentin 600 mg 2 h preoperatively and gabapentin 300 mg in the evening for 3 days postoperatively. The control group (n = 46) was given identical looking placebo capsules. Pain using a visual analogue scale (VAS) and postoperative nausea and vomiting were assessed every hour postoperatively for 6 h and then every 3 h for the next 72 h. The total consumption of fentanyl in both groups was recorded at 24 and 48 h postoperatively. RESULTS: The very low VAS scores in both groups did not differ significantly. Patients in the treatment group used less fentanyl on the second day (P = 0.001). The incidence of nausea and vomiting were similar in both groups, except for the low incidence of nausea in the treatment group in the first 6 h postoperatively. CONCLUSIONS: Perioperative gabapentin may be a component of a multimodal analgesia method because it reduced fentanyl consumption in patients who underwent TKA. However, the overall low VAS scores do not allow any firm conclusions.
Subject(s)
Humans , Analgesia , Arthroplasty, Replacement, Knee , Capsules , Fentanyl , Incidence , Methods , Mongolia , Nausea , Pain, Postoperative , Postoperative Nausea and Vomiting , VomitingABSTRACT
INTRODUCTION: Sepsis is always a serious, life-threatening condition, with high mortality rate varying from 30-50% (40-70% in septic shock) in the developed countries, and in developing countries as well. Antibiotic resistance is an important factor in sepsis management. GOAL: To evaluate the resistance patterns of microorganisms, to analyze the correlation between outcome of sepsis patient and multidrug resistant bacterial infection. MATERIALS AND METHODS: This study was designed as a prospective observational study and conducted in a nine bed multidisciplinary intensive care unit (ICU) of a tertiary teaching hospital in Ulaanbaatar, during January 2011 - August 2012. The ICU treatment outcome and length of stay were compared between the patient groups which infected by resistant and non-resistant bacteria. RESULTS: The positive rate of extensively resistant (XDR) and multi drug resistant bacteria by culture test were 22% and 25.1%, respectively. Fifty one percent of sepsis patients were infected by one or more resistant bacteria. Bacteria with an exceptionally high rate of antibiotic resistance (≥60%) were Acinetobacter baumannii, Enterobacter spp and coagulase-negative Staphylococci. Sepsis patients who were infected with resistant bacteria received more mechanical ventilation, renal replacement therapy and suffered from multiple organ dysfunctions when compared to sepsis patients with nonresistant bacterial infection. The length of stay in the ICU was longer in sepsis patients with resistant bacteria but the mortality rate in the ICU did not significantly differ between groups. However, a higher fatality rate was noted in sepsis patients infected with resistant bacteria. In conclusion, resistant bacteria were detected in up to 50% of microbiological samples from critically ill sepsis patients in the ICU of a tertiary teaching hospital in Ulaanbaatar. Antibiotic resistance appears to be a relevant problem of sepsis management in a Mongolian ICU setting.
ABSTRACT
Cancer remains the second leading cause of population mortality in the last 10 years in Mongolia. In 2009, the overwhelming majority (78.3%) of new cancer cases were diagnosed in late stages (III and IY) and 67.06% of cancer patients survived for less than a year after the diagnosis. Pain is the first symptom of cancer in 20-50% of all cancer patients, and 75-90% of advanced or terminal cancer must cope with chronic pain syndromes related to chemotherapy, failed treatment, tumor progression, and associated pathology in tumor bearing tissue. Pain limits daily activity in 41% of patients reporting mild to moderate pain and in 94% of patients reporting moderate to severe pain, leading to greatly diminished quality of life. Drug therapy controls cancer pain in 70-90% of patients with pain follows the World Health Organization’s ladder approach for pain relief. Multiple factors may contribute to dose escalation in cancer patients, including changes in endogenous opioid function, disease progression, and development of opioid-induced hyperalgesia and particularly at high doses, can be associated with severe, sometimes debilitating side effects, including somnolence, mental confusion, and especially constipation. Effective control of cancer pain can now be achieved in a high proportion of patients with rigorously applied pharmacologic treatment, reducing the need for more demanding invasive procedures. Intrathecal neurolysis is a time-tested procedure that has important indications for drug resistant severe pain. Therefore, we aimed to study the effectiveness of spinal neurolytic block in patients with cancer pain. We studied patients who suffered from pain with advanced cancer of coli uteri in ‘Hope’ hospice and Achtan Clinical hospital of Ulaanbaatar Mongolia from 2011-2012. The study participants were dvided into two groups and observed 10 weeks. In group I morphine therapy oral and injectable and the patients of group II spinal neurolytic block performed with alcohol in patient using oral morphine received. The pain was assessed by Wong Baker Score before and after celiac plexus block and also the functional score was assessed by Karnofsky performance scale. The result of the study confirm that spinal neurolysis is significantly reduced intensity of the pain, morphine consumption, incidence of drug-induced undesirable side effects and physical performance. The procedure has proved to be very useful in alleviating segmental pain. Pain relief was obtained in 78 percent of the patients, with complications in 2 percent. The technique is the standard subarachnoid puncture and injection of absolute alcohol in small increments up to 1 cc. per interspace.
ABSTRACT
Cancer remains the second leading cause of population mortality in the last 10 years in Mongolia. In 2009, the overwhelming majority (78.3%) of new cancer cases were diagnosed in late stages (III and IY) and 67.06% of cancer patients survived for less than a year after the diagnosis. Pain is the first symptom of cancer in 20-50% of all cancer patients, and 75-90% of advanced or terminal cancer must cope with chronic pain syndromes related to chemotherapy, failed treatment, tumor progression, and associated pathology in tumor bearing tissue. Pain limits daily activity in 41% of patients reporting mild to moderate pain and in 94% of patients reporting moderate to severe pain, leading to greatly diminished quality of life. Drug therapy controls cancer pain in 70-90% of patients with pain follows the World Health Organization’s ladder approach for pain relief. Multiple factors may contribute to dose escalation in cancer patients, including changes in endogenous opioid function, disease progression, and development of opioid-induced hyperalgesia and particularly at high doses, can be associated with severe, sometimes debilitating side effects, including somnolence, mental confusion, and especially constipation. Effective control of cancer pain can now be achieved in a high proportion of patients with rigorously applied pharmacologic treatment, reducing the need for more demanding invasive procedures. Intrathecal neurolysis is a time-tested procedure that has important indications for drug resistant severe pain. Therefore, we aimed to study the effectiveness of spinal neurolytic block in patients with cancer pain.We studied patients who suffered from pain with advanced cancer of coli uteri in ‘Hope’ hospice and Achtan Clinical hospital of Ulaanbaatar Mongolia from 2011-2012. The study participants were dvided into two groups and observed 10 weeks. In group I morphine therapy oral and injectable and the patients of group II spinal neurolytic block performed with alcohol in patient using oral morphine received. The pain was assessed by Wong Baker Score before and after celiac plexus block and also the functional score was assessed by Karnofsky performance scale.The result of the study confirm that spinal neurolysis is significantly reduced intensity of the pain, morphine consumption, incidence of drug-induced undesirable side effects and physical performance. The procedure has proved to be very useful in alleviating segmental pain. Pain relief was obtained in 78 percent of the patients, with complications in 2 percent. The technique is the standard subarachnoid puncture and injection of absolute alcohol in small increments up to 1 cc. per interspace.