Management of acute pancreatitis: experience of a tertiary care hospital in Peshawar

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

Combined ilioinguinal block and local infiltration anaesthesia for inguinal hernia repair

To evaluate the benefit of adding ilioinguinal block to local infiltration anaesthesia for intraoperative analgesia in inguinal hernia repair. We performed a singled blinded randomized study on 232 patients. They had inguinal hernia repair using proline Darn under local infiltration anaesthesia, with or without additional ilioinguinal block. Intra operative and three hour post operative pain was accessed using visual analogue pain scale. Pain during operation was better controlled in patient who had local infiltration anaesthesia with the addition of ilioinguinal block, showing significant P value of .0009. Similarly duration of operation was significantly shorter in these patients with the P value of .005. Combination of ilioinguinal blockade improves the intraoperative analgesia and shortens the duration of operation

Circumcision; caudal epidural block with single dose bupivacaine compared with tramadol for post operative analgesia in children

To compare the quality of postoperative analgesia with single dose Bupivacaine and that of Tramadol in caudal epidural block for circumcision in children. Interventional experimental study. This study was carried out in the department of anaesthesia and pain management at Combined Military Hospital Peshawar. Jun 30, 2004 to Mar 2005 and then from Dec 2006 to Feb 2007. Sixty [60] children between the ages of 2-6 year were included in study. They were divided into two groups by convenience non- probability technique and each group had 30 children. Group A [n=30] was given 1.25mg/kg Bupivacaine, 0.25% solution, whereas Group B [n=30] received 2mg/kg of Tramadol. The volume of drug in each group was 0.5ml/kg. Standard monitoring was done perioperatively. The analgesic effects were evaluated by using Hannallah pain score scale6, which had maximum score of 10 arid mininium of 0 [zero]. The score of 3 or <3 was considered as adequate analgesia. Sedation was assessed by using 5-point sedation test. 0 - Awake, 1 - mild sedation, 2 - feeling sleepy, 3- sleepy but able to wake, 4 - Deep sleep difficult to wake. Both the groups were comparable with respect to age, sex and duration of surgery. Insufficient pain control was observed in 4 patient's in-group B [Tramadol group], 13% and 7 patient's in-group A [Bupivacaine group], 23%, 30 minutes atter caudal administration of drug. Adequate postoperative analgesia was maintained in all other patients for 12 hrs. Only 6 patients in Tramadol group had light sedation [p=0.012]. Weakness of lower limbs was found in 4 patient's in-group A there was no difference in vital signs and there was no complication related to technique in both groups. Caudal administration of Tramadol in the dose of 2mg/kg when compared with 0.25% Bupivacaine in children under going circumcision provided similar quality of analgesia for 12 hours with out any requirement of rescue analgesic