Three-port versus four-port laparoscopic cholecystectomy - a two years experience at combined military hospital Malir cantt Karachi

Objective: To compare the safety, outcome and advantages of three port laparoscopic cholecystectomy vs. four port laparoscopic cholecystectomy

Study Design: Prospective descriptive study

Place and Duration of Study: The study was done at Combined Military Hospital Malir Cantt Karachi starting, from Mar 2013 to Oct 2015

Material and Methods: Total 200 patients who had undergone gall bladder removal laparospically were studied. Complication rate, duration of operation, insertion of 4th port, converting laparoscopic method to open, duration of hospital admission, early return to work and need of analgesics were studied in patients with three ports laparoscopic cholecystectomy [LC] vs. four ports LC

Results: A total of 200 patients who had removal gall bladder laparospically, three-port LC were performed in 117 [58.5%] patients and four-port LC was performed in 83 [41.5%] patient. There was no significant difference with respect to complication rate, converting to open technique and duration of operation were comparable to four ports LC. One patient required 4th port in left hypochondrium for liver retractor to retract enlarged left liver lobe

Conclusion: LC using thee ports can be performed safely when done by experts in this method. The said procedure has significant benefits over the conventional four-port method with respect to decreased use of pain killers and duration of hospital admission

Comparative in vitro efficacy of doripenem and imipenem against multi-drug resistant pseudomonas aeruginosa

Objective: to compare the in vitro efficacy of doripenem and imipenem against multi-drug resistant [MDR] Pseudomonas aeruginosa from various clinical specimens

Study Design: descriptive cross-sectional study

Place and Duration of Study: department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, from November 2012 to November 2013

Methodology: MDR Pseudomonas aeruginosa isolates from various clinical samples were included in the study. Susceptibility of Pseudomonas aeruginosa against doripenem and imipenem was performed by E-test strip and agar dilution methods. The results were interpreted as recommended by Clinical Laboratory Standard Institute [CLSI] guidelines

Results: the maximum number of Pseudomonas aeruginosa were isolated from pure pus and pus swabs. In vitro efficacy of doripenem was found to be more effective as compared to imipenem against MDR Pseudomonas aeruginosa with both E-test strip and agar dilution methods. Overall, p-values of 0.014 and 0.037 were observed when susceptibility patterns of doripenem and imipenem were evaluated with E-test strip and agar dilution methods

Conclusion: in vitro efficacy of doripenem was found to be better against MDR Pseudomonas aeruginosa as compared to imipenem when tested by both E-test and agar dilution methods

Fistulotomy vs. fistulectomy in the treatment of simple low anal fistula of male patients

Objective: To compare the efficacy of fistulotomy versus fistulectomy in the treatment of low lying anal fistula in male patients

Study Design: Randomized clinical trial

Place and Duration of Study: Surgery Department, CMH Multan and CMH Malir, from Aug 2008 to Oct 2013

Patients and Methods: Study was done on 262 patients. Patients with anal fistula were divided by simple random allocation into groups A [fistulotomy] and B [fistulectomy]. The patients with simple low anal fistula without any comorbids were included in the study and the patients with recurrent fistula, high fistula or those having any comorbid were excluded from the study. Data was analysed using SPSS 17. Descriptive statistics applied for both quantitative and qualitative variables. Mean and standard deviation for quantitative and frequencies and percentages for qualitative data

Results: Total 262 patients were selected having low lying anal fistula and operated as group A - fistulotomy and group B - fistulectomy, each group constituted of 131 patients each. The operating time was found to be shorter for group A [14.29+3.24 minutes] and group B [25.92 +3.60 minutes]. The group A patients were discharged earlier [3.73 + 0.65 days] than group B [4.88 + 0.35 days]. In group A incidence of postoperative bleeding [0.8%], infection [2.2%] and recurrence was [10.7%]. While in group B bleeding [3.1%], infection [3.8%] and recurrence was [15.3%]. Severity of postoperative pain [as assessed by Numeric Rating Scale] was higher in group B as compared to group A. The healing time was shorter in group A [4.04 + 0.33 weeks] as compared to group B [4.57 + 0.497 weeks] and the patients of group A returned to normal activity earlier [10.9 + 2.05 weeks] than group B patients [15.54 + 0.51 weeks]

Conclusion: In male patients suffering from simple low lying anal fistulas, fistulotomy has a definitive superiority over fistulectomy and is recommended to be adopted as primary surgical modality for the treatment

Usefulness and safety of early against delayed oral intake after appendectomy

To evaluate the usefulness and safety of early versus late oral intake after appendectomy. Randomized clinical trial. Combined Military Hospital Multan from August 2008 to February 2009. One hundred patients with uncomplicated acute appendicitis, undergoing appendectomy under general anesthesia were included in the study and randomly divided into two equal groups. Early oral intake group [group A] was allowed fluids, when patients were out of effects of general anesthesia. Delayed fed [group B] was started oral fluids, on appearance of normal bowel sounds or passage of flatus. Low residue solid diet was started, after tolerance of oral fluids, in both groups. Early oral intake resulted in start of solid diet earlier by average 9 hours; these patients had normal bowel sounds, and passed flatus, earlier, after 4 hours and 5 hours as compared to late feeding group. Six [12%] patients had mild ileus in early fed group whereas 4[8%] patients in delayed fed group had mild ileus. Thirty eight [76%] early fed patients were very satisfied, as compared to 29 [58%] delayed fed patients. The hospital stay was prolonged by 2 days in delayed fed group. Early oral feeding implemented after appendectomy is safe and effective, with a shortened hospital stay as the primary benefit in patients after appendectomy

Flare-ups following single versus multiple visits in endodontic treatment

The purpose of this study was to analyze the incidence of post-obturation flare-ups in teeth following single visit versus multiple visits in Root Canal Treatment. Two hundred patients were assigned for single-visit versus multiple visits root canal treatment. For each tooth treated, the clinical factors and conditions existing before and after the completion of treatment were recorded. This data included patient's age, gender, type of tooth, pre-operative status of pulp and periapical tissues and recording pain and swelling [flare-ups] postoperatively after 1 day,1 week and 1 month. Statistics analyzed by chi-square test, SPSS 19. Fifteen out of two hundreds cases showed flare-ups after treated single visit versus multiple visits appointments. All patients in this study suffered irrereversible pulpitis 200 patients divided into two equal groups. Group1 Patients were obturated in single visit while group 2 patients were obturated in multiple visits appointments. It was observed that out of total 15[7.5%] cases of flare-up, 6[40%] were visited multiple time and 9[60%] were visited single time. It was concluded that the incidence of flare-up or post obturation pain is related to the number of visits and clinical experience of the dentist

Extensively and pre-extensively drug resistant tuberculosis in clinical isolates of multi-drug resistant tuberculosis using classical second line drugs [levofloxacin and amikacin]

To find out the frequency of Extensively Drug Resistant [XDR] and pre-XDR tuberculosis in clinical isolates of Multi-Drug Resistant [MDR] Tuberculosis [TB] by determining the susceptibilities against Levofloxacin and Amikacin [classical second line antituberculosis drugs]. A descriptive cross-sectional study. Microbiology Department, Armed Forces Institute of Pathology [AFIP], Rawalpindi, from September 2011 to August 2013. Amikacin [AK] and Levofloxacin [LEVO] were obtained in chemically pure form from Sigma [Taufkirchen, Germany]. The breakpoint concentration used for AK was 1.0 microg/ml and for LEVO 2.0 microg/ml. Mycobacterial Growth Indicator Tube [MGIT] 960 system was used to carry out drug susceptibility testing as per recommended protocol. A total of 3 MDR-TB isolates [3%] turned out to be XDR-TB based upon simultaneous resistance to injectable second line antituberculosis drug AK and one of the fluoro-quinolones [LEVO]. A total of 24 MDR-TB isolates [24%] were found to be pre-XDR based upon resistance to LEVO alone. Treatment status record of patients with XDR and pre-XDRTB isolates revealed that majority of patients had received fluoroquinolones [FQs] during the course of treatment. XDR-TB has started to emerge in MDR-TB isolates in our set up. The worrying sign is the high frequency of pre-XDR tuberculosis. Urgent steps need to be taken to stem the tide of pre-XDR-TB in our population. It is thus recommended to develop facilities to carry out drug susceptibility testing to monitor the status of pre-XDR and XDR-TB in our population

Frequency and antimicrobial susceptibility pattern of Acinetobacter species isolated from pus and pus swab specimens

To evaluate the frequency and antimicrobial susceptibility pattern of Acinetobacter species isolated from pus and pus swab specimens at a tertiary care setting. Cross-sectional observational study. Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, from July 2008 to July 2012. Data regarding positive culture and antimicrobial sensitivity pattern was retrieved from the pus and pus swab culture records of the Microbiology Department, AFIP, Rawalpindi. Only those pus and pus swab specimens which yielded the growth of Acinetobacter species were included in the study. Out of 2781, 1848 were of pure pus while 933 were pus swab specimens. Out of 2538 culture positive isolates, 276 [10.9%] were identified as Acinetobacter species. Among 276 Acinetobacterspp., 245 [88.8%] were Acinetobacter baumannii and 31 [11.2%] were Acinetobacter johnsonii. Male/female ratio of the affected patients was 5.6:1. Doxycycline was the most sensitive antibiotic to which 45% of the tested isolates were sensitive. Sensitivity to all other antimicrobials was 15% or less. About 11% of soft tissue and wound infections are caused by Acinetobacter species in our set up particularly in male. Doxycycline was the most sensitive antibiotic. Sensitivity to all other antimicrobials was 15% or less. In vitro sensitivity to carbapenems is very low

In vitro evaluation of linezolid and meropenem against clinical isolates of multi drug resistant tuberculosis by mycobacterial growth indicator tube [MGIT] 960

To evaluate the in vitro effectiveness of multiple breakpoint concentrations of newer antituberculosis agents [Linezolid and Meropenem] against Multi Drug-Resistant Tuberculosis [MDR-TB] isolates. A descriptive cross-sectional study. Microbiology Department, Armed Forces Institute of Pathology [AFIP], Rawalpindi, from September 2011 to August 2013. A total of 100 MDR-TB isolates recovered during the study period were subjected to susceptibility testing against multiple breakpoint concentrations of Linezolid [LZD] and Meropenem [MER]. The breakpoint concentration used for LZD were 0.5, 1.0 and 2.0 microg/ml, while for MER were 4.0, 8.0 and 16 microg/ml. Mycobacterial Growth Indicator Tube [MGIT] 960 system was used to carry out drug susceptibility testing as per recommended protocol. At break point concentration of 0.5 microg/ml, 80 out of 100 [80%] MDR-TB isolates were susceptible to LZD while at breakpoint concentration of 1.0 microg/ml and 2.0 microg/ml, 96/100, [96%] of MDR-TB isolates were susceptible. For MER, at breakpoint concentrations of 4.0 microg/ml no MDR-TB isolate was susceptible, while at 8.0 microg/ml 3/100, [3%] and at 16.0 microg/ml 11/100, [11%] of MDR-TB isolates were susceptible. LZD was found to have excellent in vitro efficacy as 96% of MDR-TB isolates were susceptible at breakpoint concentration of 1.0 microg/ml or more. In case of MER it was found that in vitro susceptibility improved as the break point concentrations were increased

Antimicrobial susceptibility pattern of bacteria isolated from patients with urinary tract infection

To determine the antimicrobial susceptibility pattern of bacterial pathogens in the patients of urinary tract infection reporting at a tertiary care hospital. Laboratory based study. Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, from January to December 2012. A total of 440 culture positive bacterial isolates from 1110 urine samples; submitted over a period of one year were included in this study. Identification of bacterial isolates was done by standard biochemical profile of the organisms. The antimicrobial susceptibility of culture positive bacterial isolates was performed by disk diffusion method as recommended by Clinical Laboratory Standard Institute guidelines [CLSI]. Out of the 440 culture positive urine samples, 152 [34.6%] were from indoor patients whereas 288 [65.4%] from outdoor patients. Gram negative bacteria accounted for 414 [94%] of the total isolates while rest of the 26 [6%] were Gram positive bacteria. The most prevalent bacterial isolate was Escherichia [E.] coli 270 [61.3%] followed by Pseudomonas [P.] aeruginosa 52 [12%] and Klebsiella [K.] pneumoniae 42 [9.5%]. The susceptibility pattern of E. coli showed that 96.2% of the bacterial isolates were sensitive to imipenem, 85.1% to amikacin, 80.7% to piperacillin/tazobactam and 72.6% to nitrofurantoin. In case of P. aeruginsosa, 73% bacterial isolates were sensitive to tazobactam/piperacillin, 69.2% to sulbactam/cefoperazone and 65.38% to imipenem. The antibiogram of K. pneumoniae has revealed that 76.1% of the bacterial isolates were sensitive to imipenem and 52.3% to piperacillin/tazobactam. Nitrofurantoin and imipenem were the most effective antimicrobials amongst the Enterococcus spp. as 92.3% showed susceptibility to this bacterial isolate. Majority of the bacterial isolates were sensitive to imipenem and piperacillin/tazobactam while susceptibility to most of the commonly used oral antibiotics was very low. Among the oral antimicrobials, nitrofurantoin showed good susceptibility against Enterobacteriaceae family and Gram positive organisms

Preoperative information and informed consent in patients undergoing elective surgery at Isra university hospital, Hyderabad

The purpose of this study was to assess the patient's awareness of informed consent and to evaluate the current practice of obtaining informed consent from patients proposed for elective surgery in tertiary care hospital. Cross sectional survey. This study was conducted in Isra University Hospital, Hyderabad, Sindh from 2[nd] April 2012 to 3[rd] March 2013. This study was designed as an observational investigation and no interference was made regarding the informed consent process to the patient. The selection criteria for the patients who were interviewed were convenience sampling. All adult patients of >18 years, who were undergoing various surgical procedures were interviewed after taking verbal informed consent on the second postoperative day, when they were comfortable to answer the questions. While all those patients who were uncomfortable due to pain or other reason and were unwilling to answer the questions were excluded from the study. All the patients were asked predesigned questions related to the information they were provided before the surgery as part of standard informed consent practice. Questions were asked in local language which includes the demographic data, operative details, risk, benefit, complications of surgery, type of anesthesia and alternative treatment options etc. The data was entered on SPSS version 16. Frequency and percentages were calculated to show the results. Mean age of the patients was 34.95 +/- SD 14.236 years. 220 patients were included in the study. 183[83.18%] patients were told about the indications of surgery while 136 [61.81%] patients were not told about any complication of Surgery. Type of anesthesia was discussed in only 25[11.36%] of patients while complications of anesthesia were discussed in only 18[8.18%] of patients. 165[75%] patients were not given time to ask the questions regarding their disease or surgery. Consent by the consultants was taken in only 63[28.63%] patients. The majority of the patients knew the indication of surgery but very few were informed about the possible complications and risk of the surgery and anesthesia

Diagnostic role of bone marrow aspiration and trephine biopsy in haematological practice

To determine the usefulness of bone marrow aspiration and trephine biopsy in evaluation of the bone marrow in routine haematological practice. This study included 443 cases of bone marrow examination, referred to Pathology Department, Lady Reading Hospital Peshawar during the period extending from January 2012 till July 2013. All the bone marrow smears and bone biopsy sections were examined in detail. The diagnosis and findings on aspirate and biopsy were evaluated and compared with each other. In 73.8% of the cases the bone marrow aspiration and trephine biopsy showed same diagnosis i.e., bone marrow aspiration alone was sufficient for diagnosis in these cases. In the remaining 116 [26.2%] cases trephine biopsy sections or touch imprints were found to be necessary in for making final diagnosis. These cases were those of the hypoplastic / aplastic marrows, Myelofibrosis, lymphomatous infiltration and chronic granulomatous inflammation. The study results suggest that both the aspirate and trephine biopsy complement each other. Nutritional anaemias, Haematological Malignanciesand Immune Thrombocytopenia can be readily diagnosed by bone marrow aspiration alone. Trephine biopsy is necessary for diagnosing Granulomatous Inflammation and Hypoplastic/Aplastic Anaemia. Also trephinebiopsy is required to diagnose Myelofibrosis and Lymphomatous infiltration

In vitro activity of fosfomycin tromethamine against extended spectrum beta-lactamase producing urinary tract bacteria

To determine the in vitro activity of Fosfomycin tromethamine against extended spectrum beta-lactamase producing uropathogens. Experimental study. Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, from October 2011 to October 2012. A total of 381 culture positive ESBL producing isolates from 2400 urine samples submitted over a period of one year were included in this study. Identification of isolates was done by standard biochemical profile of the organisms. The antimicrobial susceptibility of culture positive isolates was performed by disk diffusion method as recommended by Clinical Laboratory Standard Institute guidelines [CLSI]. The antimicrobial activity of Fosfomycin to various isolates revealed that 93% of E. coli, 64% Klebsiella spp. 50% Proteus spp. 75% Enterobacter cloacae, 100% Citrobacter freundii, 100% Burkholderia spp. 100% Serratia spp. and 50% Stenotrophomonas maltophilia were susceptible to this chemical compound. Fosfomycin showed excellent effectiveness to most of the common ESBL producing bacteria such as E. coli, Klebsiella and Proteus spp

Clinicohaematological spectrum of pancytopenia in a tertiary care hospital

To determine the frequency, clinical presentation and underlying causes of pancytopenia inpatients presenting to a tertiary care hospital in Peshawar. This cross-sectional, observational study was conducted at Department of Pathology, Lady Reading Hospital Peshawar from January to December 2011. Patients of all ages having pancytopenia on blood film examination [TLC < 4000/ul, Hb < 10 gm/dl and Platelets < 150000/ul] were included in the study. Already diagnosed patients of Aplastic Anemia, Acute Leukemia receiving treatment and those not willing for bone marrow examination were excluded from the study. History, General Physical and systemic examination were recorded at presentation. The peripheral blood counts were performed with sysmex - automated hematology analyzer. Bone marrow aspiration and trephine biopsy were performed according to the standard protocol and examined microscopically to find the underlying cause of pancytopenia. Other relevant investigations were also done. During the study period, we received 600 patients for bone marrow examination from various units. Out of these, 160 [26.7%] patients had pancytopenia. Common clinical presentations were Pallor[95%, n=150], followed by generalized weakness [75%, n=120], fever [52%, n=83], bleeding manifestation[37.5%, n=60], gastrointestinal symptoms [32.5%, n=52] and splenomegaly [23.5%, n=38]. The common causes of pancytopenia were aplastic anemia [37.5%, n=60] followed by magaloblastic anemia [13.75%,n=22], Acute Leukemia [13.75%, n=22] and hypersplenism [10%, n=16]. Pancytopenia is a common occurrence. Aplastic Anemia and Magaloblastic Anemia are the commonest causes of Pancytopenia followed by Acute Leukemia. Common clinical presentations were Pallor, fever, weakness, bleeding manifestation and Splenomegaly

Pathogens causing blood stream infections and their drug susceptibility profile in immunocompromised patients

To determine the types of pathogens causing blood stream infections and their drug susceptibility profile in immunocompromised patients. Cross-sectional, observational study. Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, from January to September 2012. Blood culture bottles received from immunocompromised patients were dealt by two methods, brain heart infusion [BHI] broth based manual method and automated BACTEC system. The samples yielding positive growth from either of two methods were further analyzed. The identification of isolates was done with the help of biochemical reactions and rapid tests. Antimicrobial susceptibility of the isolates was carried out as per recommendations of Clinical and Laboratory Standards Institute [CLSI]. Out of the 938 blood culture specimens received from immunocompromised patients, 188 [20%] yielded positive growth. Out of these, 89 [47.3%] isolates were Gram positive and Gram negative each, while 10 [5.3%] isolates were fungi [Candida spp.]. In case of Gram positive isolates, 75 [84.3%] were Staphylococcus spp. and 51 [67%] were Methicillin resistant. Amongst Gram negative group 49 [55.1%] isolates were of enterobacteriaceae family, while 40 [44.9%] were non-lactose fermenters [NLF]. In vitro antimicrobial susceptibility of Staphylococci revealed 100% susceptibility to vancomycin and linezolid. The enterobacteriaceae isolates had better susceptibility against amikacin 85.7% compared to tigecycline 61.2% and imipenem 59.2%. For NLF, the in vitro efficacy of aminoglycosides was 72.5%.The frequency of Gram positive and Gram negative organisms causing blood stream infections in immunocompromised patients was equal. Vancomycin in case of Gram positive and amikacin for Gram negative organisms revealed better in vitro efficacy as compared to other antibiotics.

In vitro susceptibility of chloramphenicol against methicillin-resistant staphylococcus aureus

To determine the in vitro susceptibility of chloramphenicol against methicillin-resistant Staphylococcus aureus. Cross-sectional study. Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, from January to June 2012. One hundred and seventy four isolates of methicillin-resistant Staphylococcus aureus were included in this study using cefoxitin [30 microg] disc for detection. Minimum inhibitory concentration [MIC] of chloramphenicol against MRSA was determined by using E-strip [AB BIO DISK]. The susceptibility was determined by swabbing the Mueller-Hinton agar [MHA] plates with the resultant saline suspension of MRSA and applying E-strip of chloramphenicol from AB Biodisk Sweden and determining the MIC of chloramphenicol [in microg/ml]. Clinical and Laboratory Standards Institute [CLSI] recommendations of /= 32 microg/ml as resistant were followed in interpreting the results. Out of the 174 MRSA isolates, 132 [75.86%] isolates were susceptible to chloramphenicol with MICs of A[2] 8 microg/ml, 38 [21.84%] were resistant >/= 32 microg/ml while 4 [2.30%] were in intermediate range with MIC of 16 microg/ml. Chloramphenicol has shown good in vitro activity against MRSA and is likely to have a key role in the treatment of MRSA infections providing us a good alternative to newer expensive antimicrobials in resource limited countries

Antimicrobial susceptibility pattern of methicillin resistant staphylococcus aureus in a tertiary care setting-latest trend

To determine antimicrobial susceptibility pattern of methicillin resistant Staphylococcus aureus in a tertiary care setting. Descriptive study. Microbiology Department, Armed Forces Institute of Pathology, Rawalpindi from March 2011 to April 2012. Two hundred isolates of MRSA recovered from various clinical specimens sent to AFIP for culture and sensitivity were identified using standard microbiological techniques and the antimicrobial susceptibility was carried out employing Kirby-Bauer disc diffusion technique as recommended by Clinical and Laboratory Standards Institute. The Susceptibility pattern of isolates was recorded in percentages. Of the 200 MRSA isolated, all[100%] were susceptiblr to vancomycin and Linezolid followed by 88% to tigecycline, 81% to chloramphenicol, 66% to amikacin, 62.5% to clindamycin, 52.5% to doxycycline, 36% to trimethoprim-sulfamethoxazole, 29% to gentamicin, 28.5% to erythromycin and 26.5% to ciprofloxacin. The results show that linezolid and vacomycin hold excellent in vitro efficacy against MRSA whereas doxycyline, clindamycin, trimethoprim-sulfamethoxazole, gentamicin, erthromycin and ciprofloxacin have poor sensitivity.

Antimicrobial activity of tigecycline against methicillin resistant staphylococcus aureus in a tertiary care setting

To determine the in vitro efficacy of tigecycline against methicillin resistant Staphylococcus aureus [MRSA]. Department of Microbiology Army Medical College and Armed Forces Institute of Pathology Rawalpindi, from Feb 2008 to Jan 2009. One hundred clinical isolates of MRSA were taken, Detection of MRSA was done using 30 microg disc of cefoxitin as recommended by Clinical laboratory Standard Institute [CLSI]. Susceptibility of the isolates to tigecycline was done by employing modified Kirby Bauer disk diffusion technique, according to the guidelines provided by the Food and Durg Administration [FDA]. Minimum inhibitory concentrations [MICs] of the isolates were determined by using E-strips [bioMerieux] of tigecycline. Results were interpreted according to FDA recommendations. All MRSA isolates were susceptible to tigecycline by disc diffusion method. The MICs of tigecycline revealed that all MRSA isolates were in sensitive range. In an era of rapidly growing antibiotic resistance, tigecycline has been found to have very good in vitro efficacy against MRSA isolates

Comparison of tramadol with bupivacaine as local anaesthetic in postoperative pain control

To determine the effectiveness and duration of postoperative pain relief after local infiltration of tramadol in comparison with bupivacaine, in adult hernia surgery. Quasi experimental study. Department of Surgery, Combined Military Hospital Rawalpindi. Study was conducted on 60 patients aged between 20-60 years with elective mesh repair of inguinal hernia. Patients were divided into two groups of 30 patients for 0.25% bupivacaine [group A] and tramadol [group B]. Patients were assessed for pain at 1, 6, 12, 18 and 24 hours following surgery using visual analogue pain score [VAPS]. Patients with score =5 were given rescue analgesia in the form of 75 mg intramuscular diclofenac sodium. Comparison of first analgesia requirement time and the VAPS between the two groups was done using "t" test taking a p-value of <0.05 as significant. Patients in group A had a mean age of 46 +/- 11.03 years whereas in group B the mean age was 46 +/- 11.39 years. Mean visual analogue pain score after 1 and 6 hours of operation was 2.73 and 4.7 respectively in group A while it was 1.43 and 3.43 in group B. VAPS after 24 hours of operation was 3.47 in group A and 2.53 in group B. Mean time when 1st dose of rescue analgesic used was 8.20 hours in group A and 11.60 hours in group B. independent sample t-test for VAPS between the 2 groups revealed a highly significant difference [p-value <0.05] at 1, 6, 12 and 24 hours but no significant difference was seen at 18 hours. Independent sample t-test for time required for rescue analgesia and total number of doses required was also highly significant [p-value <0.05] between the two groups. Locally infiltrated tramadol provided an improved postoperative analgesia in comparison to bupivacaine and decreased the requirement of postoperative analgesics with early patient mobility and discharge