Comparison of general and spinal anesthesia in patients undergoing open abdominal hernia repair in terms of post-operative pain

Background and Objectives: Abdominal hernioplasty is a very common intervention that can be performed under general or spinal anesthesia. We compared general and spinal anesthesia in patients undergoing open abdominal hernia repair on elective basis

Study Design: Randomized control study

Place of Study: Allied Hospital Faisalabad

Period: September 2017 to December 2017

Methodology: Forty [40] adults received either General Anesthesia with succinylcholine, propofol, nelbuphine and atrarcurium [group A, n=20] or spinal anesthesia [L3-L4] with bupivacaine 0.5% 10mg [group B, n=20]. Then the Hemodynamic data [blood pressure, pulse], pain scores, time to first analgesic and side-effects were recorded of the patients

Results: Among the patients, hernia was supraumbilical in 6, umbilical in 7 and infraumbilical in 7 patients of group A and in 6, 6 and 8 in group B patients, respectively, p value >0.05. Maximum decrease of systolic blood pressure was 10+/-6 in group A and 21+/-6% in group B, p value <0.05 and of heart rate 11+/-5 and 17+/-7%, p value >0.05, respectively. Pain scores at 0, 2, 4 and 8 hours after surgery were: 4 [2-6], 5 [2-7], 5 [1-6] and 4 [2-6] in group A and 0, 0, 0 [0-2] and 1 [0-3] in group B, respectively, p value <0.05. Pain scores at 12 and 24 hours were 4 [1-5] and 3 [0-4] in group A and 2 [0-4] and 1 [0-3] in group B, respectively, p value >0.05. Time to first analgesic was 28+/-10 in group A and 580+/-138 min in group B, p value <0.001. 7 [35%] of the patients in group A and 1 [5%] in group B patients had post-operative nausea and vomiting, p value <0.05

Conclusion: Patients undergoing open ventral hernia repair and received general anesthesia were more stable in terms of blood pressure and heart rate but the patients who received spinal anesthesia had less postoperative pain and less post-operative nausea and vomiting

Prevalence of infertility factors in Pakistan

The incidence of various infertility factors in 1386 cases of infertility coming from different parts of Pakistan were studied at Holy Family Hospital, Rawalpindi and Women Clinic and Fertility Advisory Centre, Islamabad [WCFAC] from May 1990 to April 1992. The age, type and duration of infertility was noted: 602 couples [43.4%] had full follow up while 422 [30.4%] had incomplete follow up. The various investigations carried out to evaluate infertility factors have been discussed in detail. The results are grouped into three main groups i.e. male factor, ovulation disturbances and sperm-ovum contact hindrance, which includes tubal and pelvic factors besides other causes. It was found that tubal and other pelvic factors are responsible for infertility in 39.5% cases as compared to 15-30% quoted in various studies. Male factor was responsible in 39.39% and ovulation disturbance was seen in 43.15% which correlates well with similar incidence in literature. It is stressed that evaluation of tubal factor should be resented for specialized centres only, otherwise women are likely to become infertile while being investigated by low grade workers due to the element of sepsis causing tubal blockade. Although the treatment of infertility is not so hopeful here because of costs, yet we can at least help such women by preventing introduction of infection during the course of investigations

Pre-labour spontaneous rupture of membranes

The fetal membranes and liquor are essential for the survival of the fetus. If the membranes rupture early, the fetus is exposed to various risks. As a result of it, perinatal morbidity and mortality rate rises. A total of 125 patients with prelabour spontaneous rupture of membranes were studied. The incidence was found to be 7.09%. The perinatal mortality rate was 275/1000 total births, as compared to 84.7/1000 in the yearly hospital statistics. The women were mostly primigravidae, predominantly in third decade of life. The perinatal mortality and morbidity showed a direct relationship with rupture of membranes-delivery interval, duration of gestation, the apgar scores and weights of the infants. The perinatal mortality and morbidity reached up to 100% in cases of preterm prelabour spontaneous rupture of membranes. As rupture of membrane-delivery interval increases, the risks to the fetus due to infection, prematurity and oligohydramnios also increase. The baby should be delivered soon after rupture of membranes. In case of a preterm baby, the solution lies in an efficient neonatal care

Coordinated maternity service

Maternal and perinatal mortality and morbidity is high in Pakistan as well as well as throughout the developing world. Inspite of changes and improvements in the health care over the years, these rates consistently remain high. Various types of workers and centres of different cadres are doing perinatal care without any standardization and supervision. An assessment of perinatal care in a tehsil of District Sialkot was done to evaluate the service for the purpose of standardization. It was proposed to coordinate the maternity care provided by different cadres at different centres under the supervision of Professor of Obstetrics and Gynaecology. Pilot project was successfully done in the division, where all the centres were coordinated. As a result of these experiences a scheme is presented in which all the medical units government as well as private are incorporated. The services of all the cadres are recognised according to their training and abilities. Lower cadres are linked to the higher cadres for advise and primary, secondary and tertiary units are linked with each other and the centres of excellence. Importance of basic facilities as well as the modern technology is appropriately stressed. Role of Professor of Obstetrics and Gynecology as advisor and assessor In the capacity of Director is stressed upon. It has been realized that the existing staff in the domicilliary and institutional maternity care may be sufficient to bring the improvements if they are coordinated. Role of social and education departments, local representatives and the peripheral health organization is appropriately placed. It is hoped that institution of this scheme based on the self reliance will raise the standard of maternity and perinatal care to the higher levels of efficiency

Predictive value of postcoital test for semen analysis

Two hundred subfertile couples of varied duration of infertility were studied to establish correlation between the postcoital test [PCT] and semen analysis. 5 grades system was adopted for both investigations. There was a good correlation between good PCT and favourable results of semen analysis which comprised of 54% couples investigated. A poor PCT [lower grades] did not mean low value semen. Even absence of sperms did not mean azoospermia, but involved various factors. It is suggested that postcoital test can be recommended a preliminary test for seminal fluid evaluations instead of semen analysis. A high graded PCT obviates the need of semen analysis as the first line of investigation, which should be done only in cases of low graded postcoital tests