A Comparison of Ondansetron, Palonosetron and Granisetron for Prevention of Post-Operative Nausea and Vomiting after Laparoscopic Surgeries.

Post-Operative Nausea and Vomiting (PONV) “the little big problem” after surgery/anaesthesia is a common side-effect which compromises the quality of care, delays discharge and thereby delays resumption of activities of daily living. A number of pharmacological agents (antihistamines, butyrophenones, dopamine receptor antagonists) have been used, and the 5‑hydroxytryptamine type 3 receptor antagonists have been found to be effective in prevention and treatment of PONV. Thus, we compared the prophylactic effects of intravenously administered ondansetron, palonosetron, and granisetron in prevention of postoperative nausea and vomiting in patients undergoing laparoscopic surgery under general anaesthesia. METHODSThis prospective, double blind study, comprising of 135 patients of ASA physical status I and II of either gender, was carried out after approval was obtained from the Institutional Ethical and Scientific Committee. Patients were randomized into three equal groups. Group P received inj. palonosetron (0.075 mg), group O received inj. ondansetron (8 mg), and group G received inj. granisetron (2.5 mg) intravenously five minutes before induction of anaesthesia. The episodes of postoperative nausea and vomiting, severity of nausea, need for rescue antiemetic, side effects and patient satisfaction were observed in the study groups for 24 hours in the post-operative period. At the end of study, results were compiled, and statistical analysis was done using ANOVA, chi‑square test, and Kruskal Wallis Test. Value of p < 0.05 was considered significant.RESULTSThe incidence of PONV was significantly less in the palonosetron group (95.6%) as compared to the ondansetron group (80%) and granisetron group (73.3%), with a lesser need for rescue antiemetic in the palonosetron group. All the three study groups did not have significant adverse effects reflecting that all the three drugs were well-tolerated. Patient satisfaction score was also more with palonosetron

Comparison of efficacy and safety of ketoprofen patch versus diclofenac patch as post-operative analgesic in hysterectomy patients

Background: The objective of the study was to compare the efficacy and safety of ketoprofen patch versus diclofenac patch as post-operative analgesic in hysterectomy patients.Methods: The study was a prospective, single blind, randomized, comparative interventional clinical study conducted in a tertiary care hospital. Sixty female patients were randomly allocated to receive either ketoprofen or diclofenac patch 1 hour prior to the hysterectomy. Pain was assessed postoperatively after an interval of every four hours for 24 hours using visual analogue scale (VAS) and verbal rating scale (VRS).Results: In ketoprofen group, mean VAS was (2.92�11) significantly low as compared to diclofenac group (3.25�14). The mean VRS score in group ketoprofen (1.62�22) was low as compared to group diclofenac (1.83�16). Safety analysis revealed no apparent serious adverse events. Inj. Paracetamol 1 gm i.v was given as rescue analgesic to the patients in whom VRS >2 and VAS >5 was noted. Data were analysed using unpaired student抯 t-test.Conclusions: Transdermal patches are very convenient to use and causes less discomfort as compared to traditional routes of drug delivery. Ketoprofen patch was found better in providing analgesia after hysterectomy as compared to diclofenac patch with lesser side effects.

Succinylcholine Induced Masseter Muscle Spasm during Rapid Sequence Induction in a Pregnant Patient with Kypho- Scoliosis: Case Report

Isolated masseter spasm is a rare entity encountered in patients with neuromuscular disorders and is frequently associated with use of succinylcholine or halogenated inhalational anaesthetic during induction. We present a case of 32-year old primigravida obstetric patient with kypho-scoliosis posted for lower segment caesarean section that developed masseter muscle spasm (MMS) following administration of a standard dose of succinylcholine. The episode resolved spontaneously after 6-7 min without progression to malignant hyperthermia. The report highlights that an event of masseter muscle spasm, though, rarely encountered in life-time practice of an anaesthesiologist, may be successfully managed by maintaining oxygenation and ventilation till the crisis is tided over

Comparison of Two Different Doses of Dexmedetomidine as an Adjuvant to Intrathecal Bupivacaine in Patients Undergoing Femur Surgery.

Background: Duration of action of local anaesthetic is an important limiting factor in spinal anaesthesia. Dexmedetomidine, selective α 2- agonist has been recently used in addition to other adjuvants to prolong the duration of intrathecal local anaesthetics. Aim: To compare two different doses of dexmedetomidine added to heavy bupivacaine 0.5% intrathecally for femur surgeries. Methods: In this prospective double blind trial, one hundred and twenty patients were randomly allocated into two groups, D1 and D2. Group D1 received 12.5 mg 0.5% hyperbaric bupivacaine and 5 μg dexmedetomidine. Group D2 received 12.5 mg 0.5% hyperbaric bupivacaine and 10 μg dexmedetomidine. Results: Sensory and motor block were comparable in both groups in terms of characteristics like the highest level of sensory block achieved, time to achieve maximum sensory block and time of two segment regression, time to achieve maximal motor block and duration of regression to Bromage scale 0. However time of first analgesic request and total analgesic requirement were significantly reduced by increasing intrathecal dose of dexmedetomidine to 10 μg without any undesirable effects. Conclusion: Intrathecal dose of 10 μg dexmedetomidine provided an increased duration of sensory compared to 5μg dosing, with no significant increase in duration of motor blockade or the incidence of hypotension, bradycardia and any other undesirable side-effects.