comparison of post-operative analgesic and hemodynamic effects of extradural neostigmine plus fentanyl with fentanyl alone in patients of hysterectomy

To study the comparative analgesic and haemodynamic effects of fentanyl with a combination of neostigmine plus fentanyl administered epidurally for post-operative pain in patients undergoing hysterectomy. This is an interventional, randomized, controlled study leading to therapeutic trial of a combination of drugs. The study was conducted at High Dependency Unit [HDU], Nishtar Hospital Multan, Pakistan. The study was completed in six months period from June to December 2004. One hundred female patients belonging to age range 40 60 years, of ASA 1 and 2, undergoing elective abdominal hysterectomy, were included in this study. They were randomly divided into two groups by the consultant anaesthetist. Patients having any clinical or biochemical evidence of any systemic diseases were excluded from the study. The procedure was explained to the patients and informed consent was obtained. All the patients were examined an evening before the operation. A lumber epidural catheter was passed before induction of general anesthesia. From immediate postoperative period till 20 hours, patients were given fentanyl alone in group A and fentanyl plus neostigmine in group B by epidural infusion. While assessing the intensity of pain relief in both the groups, the effects on hemodynamics were also recorded. Significant reduction in the intensity of pain was noted in the neostigmine plus fentanyl group. Moreover lower values of mean arterial pressure were recorded in this group, while significantly slower heart rates were found in the 4 th to 7 th hours of postoperative period. Epidurally administered neostigmine along with fentanyl gives better pain [qualitative] relief than fentanyl alone. Lower values of mean arterial pressure and slower heart rates at 4,5,6 and 7 hrs of infusion were seen

effect of preoperative fluid therapy on post operative nausea and vomiting [comparison of colloids vs. crystalloids]

The objectives of this study were: To compare the incidence of postoperative nausea and vomiting in both groups. To compare the degree of postoparative pain relief in both groups. The study was done at HDU and Gynae ward II, Nishtar Hospital Multan. It was completed in 5 months period from 2nd jan 2005-2nd June 200511 was a prospective, double blind randomized controlled trial done on 70 patients, belonging to ASA I and II who were admitted for transabdominal hysterectomy. All the patients were randomly allocated to receive 5ml/kg Haes Steril 6% [group I] or 15ml/kg Hartmann's solution [group H] intravenouly shortly, before induction of anaesthesia. During the operation, fluid management was identical in both groups. Postoperatively they were kept in HDU for 12 hours. The severity of nausea, episodes of vomiting, degree of pain, and the need for supplemental antiemetic and analgesics drugs, were assessed by staff at HDU, at 0-1 hr 1-12 hr, for PONV and at 0,6,12 hrs. [for pain. Where as later on at 12-24 hrs postoperatively, these were assessed by a blinded investigator at the respective wards of the patients. Patients were asked to rate their nausea on a 100-mm VAS at 15min intervals throughout recovery [0=no nausea; 100=the worst imaginable nausea]. A score of SO mm or greater was considered significant.: During the first postoperative 24 h, postoperative nausea occurred in 3 patients [8.5%] in the group I, and in 4 patients [11.4%] in-group II [p=<0.05], whereas vomiting occurred in 2 patients in gp I and in 3 patients in gp II. The mean pain scores were also slightly lower in gp I than in gp II. We concluded from our study that colloid .substitutes administered in smaller volume produced same, rather slightly more beneficial effects on PONV and postoperative pain compared to the crystalloids given in larger volume and can therefore be of great benefit to patients with fluid restriction