Effect of diclofenac suppository on tramadol consumption in posthysterectomy pain

To determine reduction in dose of tramadol and side effects in posthysterectomy patients on addition of diclofenac on rectal suppository. Randomized double blinded placebo controlled study. The Aga Khan University Hospital, Karachi, Pakistan, from August 2004 to January 2006. Seventy ASA I and II females, aged 20 and above, who underwent elective abdominal hysterectomy, were included in this study. Patients received identical looking suppository of either 100 mg diclofenac sodium or placebo after induction of anaesthesia and then 12 hourly for 24 hours. General anaesthesia was standardized and tramadol was given by patient controlled intravenous analgesia delivery system in the recovery. The mean dose +/- SD of tramadol used in first 24 hours was found to be 317 +/- 153 mg in the placebo-tramadol group compared to 258 +/- 192 mg in the diclofenac-tramadol group [p = 0.15, 95% CI = 1.24 to -1.34, 6.63]. Seventeen [49%] patients in the placebo-tramadol group and 14 [40%] in the diclofenac-tramadol group used rescue analgesia [p=0.47]. Sedation score was similar in both the groups and there was no difference in the incidence of nausea and vomiting and use of antiemetics between the groups. This study did not show any reduction in tramadol consumption, given via patient controlled intravenous analgesia when rectal suppository of 100 mg diclofenac was added

Use of pulsed radiofrequency in failed back surgery syndrome

Failed back surgery syndrome [FBSS] is a well-recognized complication of spinal surgery. Pulse radiofrequency of dorsal root ganglion has been recently described for such patients. In this report, pulsed radiofrequency was applied in 3 patients with failed back surgery syndrome, presenting with severe pain. Reasonable to good pain relief was achieved in 2 patients in 6 months follow-up, however, one patient got short-term pain relief. Based on this limited experience in FBSS where conventional and non-conventional treatments are not effective, pulsed radiofrequency may be considered a logical choice

Efficacy of fentanyl and esmolol in the prevention of haemodynamic response to laryngoscopy and endotracheal intubation

To compare the effectiveness of single bolus dose of esmolol or fentanyl in attenuating the haemodynamic responses during laryngoscopy and endotracheal intubation. Randomized, placebo controlled, double blind study. Department of Anaesthesia and Surgical Intensive Care Unit, Civil Hospital, Karachi, from December 1998 to November 1999. Sixty adult ASA-I and ASA-II patients undergoing elective surgery were included in the study. The patients were randomly divided into three groups i.e., A, B and C. Heart rate, systolic, diastolic and mean blood pressures were recorded as 0= baseline and after administration of study drug, laryngoscopy and endotracheal intubation and 10 minutes thereafter. Study agent was injected 30 seconds before the induction of anaesthesia. Group 'A' [control] received 10 ml saline, group 'B' and group 'C' received fentanyl 2 mg/kg and esmolol 2mg/kg respectively diluted to make a total volume of 10 ml in normal saline. Readings of heart rate, systolic, diastolic and mean arterial pressures were compared with baseline and among each group. The rise in heart rate was minimal in esmolol group and was statistically significant. Following intubation, blood pressure was increased in all groups but was least in group C. Bolus injection of fentanyl 2 mg/kg 2 minutes prior to laryngoscopy and intubation failed to protect against elevation of both the heart rate and systolic blood pressure, whereas esmolol at 2mg/kg provided consistent and reliable protection against the increase of heart rate but not arterial blood pressure

Anaesthetic reasons for cancellation of elective surgical inpatients on the day of surgery in a teaching hospital

A prospect audit was conducted to find out the anaesthetic reasons for cancellation of surgical in patients on the day of surgery, and to plan for future suggestive corrective actions to reduce unnecessary cancellations. The audit was conducted at Aga Khan University Hospital for one year from 1st January to 31st December 2003. Data was collected monthly on a pre-designed form and the files of cases that were cancelled were reviewed by two consultants and labeled as justifiable or not justifiable cancellation. Eight thousand, five hundred and twenty six patients were scheduled for surgery during the study period, 359 [4%] were cancelled on the day of surgery after their names appeared on the operating room schedule. Only 28 [8%] of all cancellation were anaesthetic cancellations, 15 of which fell in nonjustifiable category. Although anaesthetic cancellations were only 0.3% of total elective admissions, this number can be improved further in the interest of the patients by implementing and following the recommendations that have been proposed following this audit