ABSTRACT
Background: Bupivacaine has been traditionally used as a local anesthetic of choice for regional anesthesia and analgesia. Ropivacaine has been marketed in our country with a claim of better motor profile, better safety profile and an equivalent analgesic profile when used in epidurals for postoperative pain. This study aims to compare both drugs as an epidural infusion in terms of safety, analgesic efficacy by NRS score and patient satisfaction score and motor blockade by modified bromage score in postoperative period
Methodology: 70 patients of ASA grade I or II, of either sex between the age of 20- 65 years, posted for orthopedic lower limb surgery under combined spinal epidural anesthesia were enrolled in this prospective randomised double blind study. The patients were randomly allocated to one of the two groups; Group 1 patients received 0.125% bupivacaine with 2 microg/ml fentanyl, while Group 2 patients received 0.2% ropivacaine, with 2 microg/ml fentanyl as an adjunct in epidural infusion postoperatively. Epidural infusion was started at the rate of 8 ml/hour after either four hours of administration of spinal anesthesia or at an NRS score of three, whichever was earlier. We evaluated the NRS scores, patient satisfaction scores and the need of rescue analgesic. Vital parameters and modified bromage score were also registered
Results: The pain score was similar in both groups at different time intervals, except at 15 and 30 min after starting epidural infusion, where the pain score was significantly lower in Group 2 when compared to Group 1 [p-value 0.007, 0.006 respectively]. Patient satisfaction score was significantly more in Group 2 patients. There was no significant difference in requirement of rescue analgesia in two groups. Modified bromage grade was statistically more in Group 1
Conclusion: We conclude that ropivacaine can be used as an alternative to bupivacaine for postoperative analgesia by epidural infusion, as it provides effective pain control with the added advantage of lower incidence of motor blockade
ABSTRACT
Background: Though India has made efforts to increase access to reproductive health care, the progress has been uneven and inequitable. There are a large number of women who still lack access to maternal and reproductive health care. The study was hence conducted with the objective of observing morbidity pattern and health seeking behavior of women in reproductive age in slums of Amritsar city. Methods: By adopting convenience sampling, 50 clusters of married women in 15-45 year of age, from different slums of Amritsar city were included in the study. They were interviewed by using pre-designed, pre-tested proforma. Data was compiled and analyzed. Results: It was observed that 53.1% women had one or more health problems. Pregnant women were 1.68 times more likely to have health problems in comparison to non-pregnant women (OR=1.68, CI = 1.07-2.65, P = 0.03) and the difference was statistically significant. But, only 25.2% women sought treatment for their health problems and 19.3% women took treatment from qualified health practitioner. Availability of ration card for their identity, their caste, type of family, literacy status of women and their socioeconomic status were significant factors affecting treatment seeking behavior of women. Conclusions: Though a large number of women in reproductive age had one or more health problems, only few of them took treatment from qualified practitioners. Attention needs to be paid to significant factors affecting their health seeking behavior so that health of women could be improved.
ABSTRACT
We describe a patient with an extramedullary plasmacytoma (EMP) of the mandible. which presented a diagnostic and therapeutic challenge on several levels. We discuss herein the clinical presentation surgery and the role of radiotherapy in this rare case.