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

comparison of epidural and intramuscular buprenorphine in patients following lower abdominal surgery

This Analytical study aimed to assess and compare the efficacy of Epidural route with n the duration of analgesia and degree of ostoperative pain relief in patients undergoing lower abdominal surgery. The objectives of this study were to: compare the duration of analgesia in two regimens, compare the degree of pain relief in two regimens The study was conducted at general surgical wards I and II in Nishtar hospital Multan over a period of six months from 1st April - 30th September 2003. Sixty patients of either sex belonging to age range 40-60 years, of ASA grade I and II, undergoing elective lower abdominal surgery were included in this study. Patients having any clinical or biochemical evidence of systemic involvement were excluded from the study. Patients having local sepsis, or patients with history of allergy or sensitivity to buprenorphine or those suffering with fever during postoperative period were excluded. Sixty patients were included in this study, all were assigned to one of the two groups I and II, using non probability convenience sampling technique. Each group comprised of thirty patients. Group I received epidural Buprenorphine 0.3mg in 9 ml of normal saline, through epidural catheter Group II received parenteral Buprenorphine 0.3 mg. I/M deep into deltoid muscle. All patients underwent surgery under general anaesthesia, but no narcotic analgesia was given in preoperative or intraoperative period. Prior to induction in group I, epidural catheter was passed at L1-2 or L2-3 intervertebral space and at the time of closure of peritoneal cavity 0.3mg Buprenorphine, in 9 ml of normal saline was given in it; where as Group II was given injection Buprenorphine 0.3 mg IM deep into the deltoid muscle at the time of closure of peritoneal cavity" Patients were transfered to the HDU where they remained for 24 hours. Patients were instructed to ask for analgesia as soon as pain at rest returned. In postoperative period pain intensity was evaluated at 0, I, 4, 8,12,16,20,24 hrs interval after completion of operation using a 10 cm Visual Analogue Scale and with the help of McGill questionnaire. In group I, excellent analgesia of longer duration was noted, with no hemodynamic as well as immediate respiratory depressant effects. Moreover, drowsiness as compared to group II was much less

Effect of buprenorphine, pentazocine and tramadol on respiration

The purpose of this study was to evaluate the effects of Bupernorphine, Pentazocine and Tramadol on Respiration. Study design: This is a prospective study. Place and duration of study: This study was conducted at Intensive Care Unit of Nishtar Hospital, Multan from July to December 2001. Patients and method: Sixty patients belonging to age group ranging between 18-35 years, of ASA-I and II grades undergoing elective cesarean section were selected. All the patients suffering from severe systemic disease, not falling in ASA 1 or 2 and patients allergic to Opioids were excluded from the study. Patients were divided into three groups using the non-probability convenience sampling technique. Each group comprised of 20 patients. All the patients received endotracheal general anesthesia. In postoperative period Group-A received injection Bupernorphine 0.5mg IM. Group-B received injection Pentazocine 30mg IM and Group-C received Tramadol 100mg IM for pain relief. The effects on respiratory rate, tidal volume, minute volume and arterial blood gases were evaluated 30 minute, 1 hour, 2 hour and 4 hour after giving analgesia. Dosages were repeated 8 hourly. Bupernorphine led to a fall in respiratory rate and minute volume in 30 minute, whereas Pentazocine decreased the respiratory rate after 30 minute but minute volume was decreased in 5 minute, where as Tramadol had no effect on respiratory rate and minute volume. Pa02 was decreased within 30 minute with Bupernorphine and Pentazocine where as PaC02 raised after 60 minutes with Bupernorphine but within 5 minute with Pentazocine where as with Tramadol there was no significant alteration in arterial blood gas values. Opioids have a respiratory depressant effect which manifested within 30-60 minute of IM administration, where as Tramadol which is a non opioid, does not cause respiratory depression in equiv. potent doses