Inkk Trial - Intraoperative ketamine for perioperative pain management following total knee endoprosthetic replacement in oncology: a double-blinded randomized trial

Abstract Background There has been a growing interest in the use of ketamine following orthopedic surgeries. We hypothesized that low dose intravenous ketamine during surgery would help in mobilization following total knee replacement (TKR) in oncology patients as assessed by the timed to up and go (TUG) test at 72 hours post-surgery. Our secondary objectives were to compare the opioid requirement at the end of 72 hours, pain scores, satisfaction with pain management, adverse effects, range of joint movement achieved in the post-operative period and the functional recovery at the end of 1 month. Methods After the ethics commitee approval, registration of the trial with the Clinical Trial Registry - India (CTRI), and informed consent, this double-blinded trial was conducted. Using computer generated randomization chart, an independent team randomized the patients into ketamine group which received at induction, a ketamine bolus dose of 0.5 mg.kg-1 before the incision followed by 10 µg.kg-1min-1 infusion which was maintained intraoperatively till skin closure and the saline group received an equivalent volume of saline. Postoperatively, patient controlled morphine pumps were attached and the pain score with morphine usage were recorded for 72 hours. The TUG tests and range of motion were assessed by the physiotherapists until 72 hours. Results Fifty-two patients were enrolled in the trial. Demographics were comparable. No significant intraoperative hemodynamic changes and post-operative adverse events were noted between the groups. A decrease in the TUG test, along with decreased opioid usage with a better range of movements was noted in the ketamine group, but this was not statistically significant. Day of discharge, patient satisfaction score, and functional recovery assessed by Oxford Knee Score (OKS) were comparable between the groups. Conclusion In conclusion, low dose intraoperative ketamine infusion does not provide clinical benefit in perioperative pain management and postoperative rehabilitation following total knee endoprosthetic replacement in oncology.

Role of WhatsApp-based discussions in improving residents' knowledge of post-operative pain management: a pilot study / 대한마취과학회지

BACKGROUND: To provide a platform for the dissemination of basic knowledge of pain management, a WhatsApp group was created by residents and consultants. Common clinical scenarios, resident queries, and important instructions to be followed by residents with respect to running the Acute Pain Service were discussed in the group. This study evaluates the benefits of this interaction. METHODS: This study was approved by the hospital ethics board and was registered with the Clinical Trial Registry of India. Second- and third-year anesthesia residents were included in a WhatsApp group, along with consultants (board certified anesthesiologists with a special interest in pain). Pain knowledge assessment was performed pre- and post-discussion using a standard 22-point questionnaire. A feedback form, which included self-rated confidence scores (1–10, 10-most confident) and opinions about the 3-month WhatsApp discussion, was collected. Improvements in the documentation in clinical sheets post-discussion were also analyzed. RESULTS: A total of 38 residents were included in the WhatsApp group. An improvement in the percentage of correct answers from 69.1% (pre-discussion) to 73.6% (post-discussion) was observed (P = 0.031). Improvements in the self-rated residents' confidence levels were also noted (P < 0.05). A total of 37 residents felt that the WhatsApp-based discussion was useful. Documentation of the details of epidural blockade in clinical sheets improved from 30% to 100%. CONCLUSIONS: The WhatsApp discussion improved residents' knowledge and confidence levels, and also resulted in improved documentation of essential details in the clinical notes. This form of education is promising and should be explored in future studies.

Personality profile among Human Immunodeficiency Virus (HIV) positives and Acquired Immunodeficiency Syndrome (AIDS) patients of injecting drug users.

OBJECTIVE: The purpose of the study was to find out the various personality factors among HIV/AIDS patients of injecting drug users. MATERIALS AND METHODS: The study was conducted during the period of July 2001 to August 2004 at Manipur State, India in which 60 samples of both male and female in the age range of 21 to 35 years were taken through the helps from R.I.M.S Hospital, Imphal, J.N. Hospital, Imphal and several NGOs of Manipur. The patients were administered 16 PF (Personality profile developed by R.B. Cattell and H.W. Eber) test in which 16 personalities were detected. RESULTS: The profile of the respondents includes age and sex cases of HIV/ AIDS. In the sample among the HIV/AIDS patients, from the age group of 21 to 25 years consists of only 20%. Most of the patients are from 26 to 35 years consisting of two age groups, i.e., 26 to 30 years and 31 to 35 years having 40% each with total of 80%. In the survey, it has been found that majority of the HIV/AIDS patients is male which consists of 60% and remaining 40% belongs to female in the ratio of 60:40. The following four scales are used to explain personality profile: 1 Introversion vs extraversion. 2 Low anxiety vs high anxiety. 3 Emotional sensitivity vs tough poise. 4 Subdueness vs independence.