Comparative Evaluation of Pregabalin and Clonidine as Preemptive Analgesics for the Attenuation of Postoperative Pain Following Thoracolumbar Spine Surgery

STUDY DESIGN: Prospective, randomized, double blind, placebo-controlled study.PURPOSE: To compare clonidine and pregabalin with placebo for the attenuation of postoperative pain after thoracolumbar spinal surgery and instrumentationOVERVIEW OF LITERATURE: Spine surgery is associated with moderate to severe postoperative pain that needs to be controlled to improve patient’s outcome. Alpha 2 agonists (e.g., clonidine) and gabapentenoids (e.g., pregabalin) are successfully used as part of a multimodal analgesic regimen.METHODS: Total 75 patients were enrolled and randomly allocated into three groups. Group P received pregabalin (150 mg), group C received clonidine (150 mcg), and group N received placebo 90 minutes preoperatively. A standard anesthesia protocol comprising fentanyl, thiopentone, vecuronium, nitrous oxide, and oxygen in isoflurane was used for all patients. Postoperative recovery profile, pain, time for first analgesic, 24-hour analgesic requirement, sedation, and hemodynamic parameters were noted.RESULTS: Recovery profile was similar in all three groups; however, the patients in group P and C were more sedated (p<0.05). Group N patients had a higher Visual Analog Scale (VAS) score (p<0.05) and the time for first analgesic was also lower (p=0.02). Postoperative (24-hour) analgesic requirement was maximum in group N, followed by that in group C and group P. The VAS score was highest in the control group; however, after 12 hours, it was similar in all groups.CONCLUSIONS: Postoperative pain and analgesic requirement is significantly attenuated by preoperative administration of a single dose of clonidine (150 mcg) or pregabalin (150 mg); pregabalin was more effective. Thus, their use offers a reasonable strategy for pain management in patients undergoing spine surgery.

Tinospora cordifolia induces cell cycle arrest in human oral squamous cell carcinoma cells

Natural products with medicinal value are gradually gaining importance in clinical research due to their well-known property of no side effects as compared to drugs. Tinospora cordifolia [Guduchi] has been used for centuries in Ayurvedic system of medicine for treating various ailments including cancer. In present study, we found that the Tinospora cordifolia extracts [TCE] induced inhibition of proliferation of KB cells was associated with arrest of GO/G1-phase of cell cycle. The effectiveness of TCE in checking the growth of KB cells without altering the growth of normal peripheral blood mononuclear cells [PBMC] indicates that Tinospora cordifolia has differential effect on normal and malignant cells hence, it may have therapeutic potential in cancer

Inferior rectus muscle ocular cysticercosis: a case report

Cysticercosis is a systemic parasitic disease caused by the larval form of cestode Taenia solium. It has a worldwide distribution and is potentially harmful with variable clinical manifestations. The most commonly involved sites include eye, brain, bladder wall, and heart. Ocular cysticercosis can be extraocular or intraocular and may present with varied clinical symptoms. We report the condition in a thirteen year old female child who presented with mild lower lid swelling and diplopia in upgaze, wherein cysticercus cellulosae cyst was found within the mass of the right inferior rectus muscle. It becomes important to report this case because of the relative rarity of the condition these days, unusual site of the cyst and the young age of the patient

Validity of Clinical Signs and Symptoms in Diagnosis of Ovarian Mass.

Objective: The main aim for undertaking this study was to find out what was the appropriateness of clinical diagnosis of benign ovarian tumor and compare the results after Histopathological study. Material And Methods: Retrospective files study of 240 cases was carried out to analyze the clinical signs and symptoms and evaluation done of clinical findings, tumour marker study, ultrasonography, and the plan of treatment. Results: Laparotomy was done in 200 cases, clinically ovarian masses were diagnosed as benign in 75%, by Tumor marker i.e. CA125 in 80%, by sonography in 70% and by histopathology in 83%. The study was statistically analyzed. The values in diagnosis of ovarian mass clinically and comparing with other parameters was significant p value<0.05. Conclusion: Clinical signs and symptoms are still important predictors in reaching the diagnosis of benign Ovarian Mass.

Vascular endothelial growth factor [VEGF-634G/C] polymorphism and retinopathy of prematurity a meta-analysis

Vascular endothelial growth factor polymorphism [VEGF-634G/C, rs 2010963] has been considered a risk factor for the development of retinopathy of prematurity [ROP]. However, the results remain controversial. Therefore, the aim of the present meta-analysis was to determine the association between VEGF-634G/C polymorphism and ROP risk. Published literature from PubMed and other databases were retrieved. All studies evaluating the association between VEGF-634G/C polymorphism and ROP risk were included. Pooled odds ratio [OR] and 95% confidence interval [Cl] were calculated using random or fixed effects model. A total of six case-control studies including 355 cases and 471 controls were included. By pooling all the studies, we found that VEGF-634G/C polymorphism was not associated with ROP risk at co-dominant and allele levels and no association was also found in dominant and recessive models. While stratifying on ethnicity level no association was observed in Caucasian and Asian population. This meta-analysis suggests that VEGF-634G/C polymorphism may not be associated with ROP risk, the association between single VEGF-634G/C polymorphism and ROP risk awaits further investigation

The study of hyperostosic variants: significance of hyperostotic variants of human skulls in anthropology / 대한해부학회지

Minor variations in the ossicles, foramina and ridges of the cranium have aroused the curiosity of anatomists for many decades. These non-metric variants help us to study the genetic relationships among ancient populations. Since these traits show considerable frequency differences in different populations, they can be used as anthropological characters in epidemiological studies. These variants indirectly reflect the part of underlying genotype of a given population thus implying their usefulness in biological comparisons of related groups. They can be used for the assessment of the existence of the parental structures within a community or as taxonomic indicators. For anthropological studies, the traits should be genetically determined, vary in frequency between different populations and should not show age, sex, and side dependency. The present study was conducted on hundred dry adult human skulls from Northern India. They were sexed and studied for the presence of hyperostotic traits (double hypoglossal canal, jugular foramen bridging, and paracondylar process). Sexual and side dimorphism was observed. None of the traits had shown statistically significant side and sexual dimorphism. Since the dimorphism is exhibited by none of them, it can be postulated that these traits are predominantly under genetic control and can be effectively used for population studies.

Anesthesia implications in emergency oncologic surgery in a case of untreated Parkinsonism

Oncologic surgery has made tremendous advancements in the last two decades. The prognosis of once thought to be irreversible and incurable diseases has improved dramatically with these advancements, which have given a fresh lease of hope to the general population. But there are certain factors that are still unfavorable for achieving improved outcome of surgery in various cancers. The associated comorbid diseases do determine to a large extent the actual outcome of all the interventions to treat oncologic disease. The untreated coexisting disease makes the task of the attending anesthesiologist very challenging as numerous complications are anticipated, especially during emergency surgery. We are describing a case of a patient with endometrial carcinoma who presented with unstoppable bleeding per-vaginum and was suffering from Parkinson disease since 1.5 years, for which no treatment was ever sought. Vaginal hysterectomy was performed under graded epidural anesthesia; and after a smooth and uneventful postoperative period of 8 days, she was referred to radiotherapy unit for further management

Anesthetic considerations and difficult airway management in a case of Noonan syndrome

Noonan syndrome is a genetically transmitted autosomal dominant disorder characterized by various anatomic anomalies and pathophysiologic derangements. Anesthetic management in such cases poses a multitude of challenges, especially related to the airway management and maintenance of cardiovascular stability. We report a case of a 9-year-old male child weighing 24 kg, who was diagnosed as a case of Noonan syndrome and had undergone ligation of patent ductus arteriosus during early childhood. The child was operated on for release of bilateral neck bands under general anesthesia. The case report pertains to the successful airway and anesthetic management in the background of difficult airway and existence of various cardiac lesions

Palonosetron: a novel approach to control postoperative nausea and vomiting in day care surgery

Postoperative nausea and vomiting [PONV] is one of the complications which hamper the successful implementation of day care surgical procedure in spite of the availability of so many antiemetic drugs and regimens for its prevention. The aim was to compare the prophylactic effects of intravenously [IV] administered ondansetron and palonosetron on PONV prevention in patients undergoing laparoscopic gynecological surgery under general anesthesia. A prospective double-blind study comprised of 60 ASAI/II female patients between the age group of 25 and 40 years was carried out in the Departments of Anesthesiology and Obstetrics and Gynecology of our institute. Patients were randomly divided into two groups of 30 patients each in a double-blind manner. Group I received 8 mg of inj. ondansetron IV while group II received inj. palonosetron 0.075 mg IV 5 minutes before the induction of anesthesia. The need for rescue antiemetics, episodes of PONV and other side effects were observed for 6 hours in the postanesthesia care unit and thereafter complaints were received on phone after the discharge. At the end of study, results were compiled and statistical data was subjected to statistical analysis using Student two-tailed [t] and X[2] test and value of P<0.05 was considered significant. The demographical profile of the patients was comparable. Twenty and 13.33% of the patients in group I had nausea and vomiting episodes postoperatively as compared to 6.67% and 3.33%, respectively, in group II which was statistically significant [P<0.05]. Twenty percent of the patients in group I experienced significant post-op headache as compared to 6.67% in group II. The mean rescue dose of antiemetic was significantly higher [10.6 mg] in the group I as compared to group II [6.4 mg] [P = 0.036]. The rest of parameters were comparable and statistically nonsignificant. Palonosetron is a comparatively better drug to prevent the PONV in patients undergoing day care surgical procedures as compared to ondansetron as it has got a prolonged duration of action and favorable side-effects profile

Comparative evaluation of dexmedetomidine and fentanyl for epidural analgesia in lower limb orthopedic surgeries

Opioids as epidural adjunct to local anesthetics [LA] have been in use since long and alpha-2 agonists are being increasingly used for similar purpose. The present study aims at comparing the hemodynamic, sedative, and analgesia potentiating effects of epidurally administered fentanyl and dexmedetomidine when combined with ropivacaine. A total of one hundred patients of both gender aged 21-56 years, American Society of Anaesthesiologist [ASA] physical status I and II who underwent lower limb orthopedic surgery were enrolled into the present study. Patients were randomly divided into two groups: Ropivacaine + Dexmedetomidine [RD] and Ropivacaine + Fentanyl [RF], comprising 50 patie nts each. Inj. Ropivacaine, 15 ml of 0.75%, was administered epidurally in both the groups with addition of 1 microg/kg of dexmedetomidine in RD group and 1 microg/kg of fentanyl in RF group. Besides cardio-respiratory parameters and sedation scores, various block characteristics were also observed which included time to onset of analgesia at T10, maximum sensory analgesic level, time to complete motor blockade, time to two segmental dermatomal regressions, and time to first rescue analgesic. At the end of study, data was compiled systematically and analyzed using ANOVA with post-hoc significance, Chi-square test and Fisher's exact test. Value of P<0.05 is considered significant and P<0.001 as highly significant. The demographic profile of patients was comparable in both the groups. Onset of sensory analgesia at T10 [7.12 +/- 2.44 vs 9.14 +/- 2.94] and establishment of complete motor blockade [18.16 +/- 4.52 vs 22.98 +/- 4.78] was significantly earlier in the RD group. Postoperative analgesia was prolonged significantly in the RD group [366.62 +/- 24.42] and consequently low dose consumption of local anaesthetic LA [76.82 +/- 14.28 vs 104.35 +/- 18.96] during epidural top-ups postoperatively. Sedation scores were much better in the RD group and highly significant on statistical comparison [P<0.001]. Incidence of nausea and vomiting was significantly high in the RF group [26% and 12%], while incidence of dry mouth was significantly higher in the RD group [14%] [P<0.05]. Dexmedetomidine seems to be a better alternative to fentanyl as an epidural adjuvant as it provides comparable stable hemodynamics, early onset, and establishment of sensory anesthesia, prolonged post-op analgesia, lower consumption of post-op LA for epidural analgesia, and much better sedation levels

Comparison of epidural ropivacaine and ropivacaine clonidine combination for elective cesarean sections

Neuraxial adjuvants augment the action of local anesthetics. The aim is to determine the qualitative and quantitative aspects of epidural block of ropivacaine 0.75% versus ropivacaine 0.75% with clonidine for elective cesarean section . A randomized double-blind study was conducted among 51 healthy parturients, scheduled for elective cesarean section, at Gian Sagar Medical College and Hospital, Banur, Punjab, India. Epidural block was administered with 20 ml of ropivacaine 0.75% [group R] and ropivacaine 0.75% and clonidine 75 microg [group RC] and anesthetic level was achieved minimum until T6-T7 dermatome. Onset time of analgesia, sensory and motor block levels, maternal heart rate and blood pressure, neonatal Apgar scores, postoperative analgesic dose and adverse events were recorded. Fifty one patients were enrolled in this study and were subjected to statistical analysis. Groups were comparable with regard to demographic data, neonatal Apgar scores and incidences of side effects except for the higher incidence of dry mouth in patients of RC group. Onset of analgesia was much shorter in RC group along with prolonged duration of analgesia. The incidence of bradycardia and hypotension was more in RC group as compared to R group which was statistically significant. The dose requirement for postoperative pain relief was significantly lesser in RC group. The addition of 75 microg clonidine to isobaric epidural ropivacaine results in longer, complete and effective analgesia with similar block properties and helped to reduce the effective dose of ropivacaine when compared with plain ropivacaine for cesarean delivery

Comparison of two drug combinations in total intravenous anesthesia: Propofol-ketamine and propofol-fentanyl

Keeping in consideration the merits of total intravenous anesthesia [TIVA], a genuine attempt was made to find the ideal drug combinations which can be used in general anesthesia. This study was conducted to evaluate and compare two drug combinations of TIVA using propofol-ketamine and propofol-fentanyl and to study the induction, maintenance and recovery characteristics following anesthesia with these techniques. A case control study was conducted, which included 100 patients, in the department of Anaesthesiology and Intensive care, Government Medical College and Hospital, Patiala. A hundred patients between the ages of 20 and 50 years of either gender were divided into two groups of 50 each, and they underwent elective surgery of approximately 1 h duration. Group I received propofol-ketamine while group II received propofol-fentanyl for induction and maintenance of anesthesia. All the results were tabulated and analyzed statistically with student's unpaired t-test and chi-square test. Propofol-fentanyl combination produced a significantly greater fall in pulse rate [PR; 9.28% versus 0.23%] and in both systolic [7.94% versus 0.12%] and diastolic blood pressures [BP; 8.10% versus 0.35%] as compared to propofol-ketamine during induction of anesthesia. Propofol-ketamine combination produced stable hemodynamics during maintenance phase while on the other hand propofol-fentanyl was associated with a slight increase in both PR and BP. During recovery, ventilation score was better in group I while movement and wakefulness score was better in group II. Mean time to protrusion of tongue and lifting of head was shorter in group I. Both propofol-ketamine and propofol-fentanyl combinations produce rapid, pleasant and safe anesthesia with only a few untoward side effects and only minor hemodynamic effects