ABSTRACT
The aim of this study was to assess the analgesic efficacy of Bupivacaine application at port-site and intraperitoneal infiltration in patients with laparoscopic cholecystectomy. Randomized Controlled Clinical Trial. The study was conducted at Rehman Medical Institute [RMI] Peshawar, Pakistan from June 2009 to June 2012. Patients who underwent elective laparoscopic cholecystectomy during the study period were included in the study. Eighty patients were randomized into two groups, study group and control group. The study group received 40 ml of 0.25% bupivacaine intraoperatively as intraperitoneal infiltration and local infiltration at the port sites. Pain assessment was done using visual analogue pain score [VAS] of 0-10 at fixed intervals during .the first 24 hours post surgery. The mean VAS score in the study group was less as compared to the control group throughout the 24 hours assessment period, however this difference was statistically significant [p<0.001] only during the first three assessments at 1 hour, 4 hours and 8 hours post surgery. The analgesia requirement was also significantly [p<0.001] decreased in the study group. Port site and intraperitoneal application of local anesthetic bupivacaine significantly reduced pain during the first 8 hours post surgery and total analgesia requirement was also significantly reduced. It is a simple and easily applicable technique which increases patient comfort and can be safely used to decrease post operative pain in patients undergoing laparoscopic cholecystectomy
Subject(s)
Humans , Male , Female , Cholecystectomy, Laparoscopic , Pain, Postoperative/drug therapyABSTRACT
To document the frequency and risk factors of Hepatits B and C in Afghan patients presenting to a tertiary care hospital in Peshawar. Descriptive study. Rehman Medical Institute [RMI], Peshawar from 1st January, 2012 to 31st December, 2012. A total of 2166 Afghan national were included in the study who underwent surgery in RMI through consecutive, non-probability sampling. Hepatits B surface antigen [HBsAg] and anti-HCV antibody tests were performed by ELISA method. All patients who were positive for either of the two or both were investigated by a researcher-administered questionnaire to find the risk factors for seropositivity of hepatitis. Out of a total of 2166 patients, 104 patients [4.8%] were found to be positive. Seventy-eight patients [75%] were HepBsAg positive while 24 patients [23%] were anti-HCV antibodies positive while 2 patients were positive for both viruses. Re-use of unsterilized syringes [23%] and history of previous surgery [19.2%] were the most common risk factors whereas no risk factor could be identified in 15 patients [14%]. Seventynine patients [76%] were newly diagnosed at time of test while 25 patients [24%] were known cases of either HBV or HCV. Only one patient had clinical/laboratory features of chronic liver disease while no patient had underwent Hep B vaccination or had hepatocellular carcinoma. A high seroprevalance of HBV and HCV was found in this study. Reuse of unsterilized syringes, history of previous surgery and tattoos piercing were found to be the most common risk factors
ABSTRACT
To document the frequency, age, gender, etiology, mortality and morbidity of patients suffering from acute pancreatitis [AP] and managed at a tertiary care hospital. This prospective, descriptive, institution-based study was conducted in Department of Surgery, Rehman Medical Institute [RMI], Peshawar [Pakistan], from June 2010 to June 2013. All patients with acute pancreatitis admitted to our institute were managed with a set protocol. Consecutive, non-probability sampling was done. Data were collected from all patients by a single investigator using a researcher-administered questionnaire, which included patient demographics, various risk factors, treatment options, complications and mortality. A total of 47 patients were included in the study; 28 female and 19 male patients. Out of 47 patients 35 [74%] were of Afghan origin, while 12 [26%] were Pakistani. Majority of patients [57%] were between 20-40 years of age. Gall stone pancreatitis [GSP] was the cause of AP in 13 [28%], dyslipidemia in 9 [19%], and traumatic AP in one patient, while in 24 patients [51%] it was idiopathic. Ten [21%] patients developed pseudocyst. Out of a total of 47 patients, 3 [6%] expired. Patients suffering from acute pancreatitis and presenting to our hospital had a predominance of females. Majority of patients were between ages of 20-40 years. Idiopathic pancreatitis was the most common type followed by GSP. Mortality and morbidity in this study was low in comparison to other local studies
ABSTRACT
To document the early outcome of stapled hemorrhoidopexy, the procedure for prolapsed and hemorrhoids [PPH]. Descriptive case series. Rehman Medical Institute [RMI], Peshawar; from May 2012 to May 2013. A total of 24 patients requiring surgical treatment for prolapsing hemorrhoids of degree II and III were included in the study. Outcome measures were postoperative pain, bleeding, sepsis, urinary retention, relief of preoperative symptoms, operation time and length of hospital stay. Mean age of patients was 46.8 year. All surgeries were performed under spinal anesthesia. Mean surgical time was 22.5 minutes. The average distance between the stapling line and the dentate line was 2.6 cm. Postoperative pain at rest and during defecation was mild to moderate after PPH. Healing time was shorter after PPH and no patient had perioperative or postoperative bleeding. Postoperative pain was mild to moderate in majority of patients. There were no intraoperative or postoperative complications. PPH was a safe procedure and resulted in swift recovery and earlier return to work