assessment of postoperative levels of pain with reference to validated protocols at a hospital in Karachi Pakistan

Objective: The aim of study is to assess the postoperative levels of pain in accordance with established protocols

Method: The type of study is a hospital wide survey conducted from February 2014 to April 2014, at department of surgery and associated wards, at a tertiary care hospital in Karachi Pakistan. World Health Organization pain scoring system was used as a base to develop a questionnaire to assess the level of pain. The results were correlation with various other variables involved

Results: The study was conducted on 200 patients out of whom 38% [n=76] were males having mean age of 44.16 +/- 20 and 62% [n=124] were females having mean age of 36 +/- 14.5 years. Generally patients experiences mild pain [40%], moderate [39%] severe [16%] and no pain [5%] when recorded after 24 hours postoperatively. While after 48 hours the scores recorded for the same patients were as, mild [56%], moderate to severe [34%] and in the no pain group [10%] of patients were recorded

Conclusion: It is noted that absolute pain free surgeries are not possible at the moment, but with the use of latest advancements in the field of health sciences, post-operative pain can be minimized and should be the one of the prime goals for a good surgical outcome

To determine the efficacy of locking compression plating in comparison with intramedullary nailing for humeral shaft fractures at a tertiary care hospital in Karachi, Pakistan

Objective: The purpose of our study is to compare the effectiveness, surgical outcome and complications of locking compression plating as compared with intramedullary nailing for the purposes of fixation of humeral shaft fractures in the adult population

Methodology: The type of study is a prospective randomized controlled trial, which was carried out for a period of three years from Jan 2012 to December 2014, at a tertiary care hospital in Karachi Pakistan. Patients coming to the hospital via the A and E department with radiographic evidence of a humeral shaft fracture were included in the study. 50 patients were selected for the study, who were randomly divided into two groups, group A [n=25] comprised of patients who underwent intramedullary nailing procedure, while group B [n=25] patient underwent compression plating for the fixation of the humeral fracture. The surgical outcome was assessed based on the operative time, intra operative blood loss, the time of hospital stay, the time required for the union of bone, functional outcome and complications. [American shoulder and elbow surgeons score] ASES and the constant score was used to assess the functional outcome of patients

Results: According to our study, the operative time, hospital stay and intra operative blood loss was much lower in group A [the intramedullary nail group] as compared to those in the group B [locking compression plate group]. The rate of bone union, constant and ASES score did not show any significant difference. The union time for group A was lower as compared to group B. Complications such as radial nerve palsy were observed to be associated more with the locking compression plate as compared with the group of patients who underwent intramedullary nailing

Conclusion: According to our study the intramedullary nailing technique for the repair of humeral shaft fractures is a superior technique as compared to the locking compression plate, as it has decreased incidence of blood loss during the procedure, less time required for the procedure, less time of hospital stay and union of bone. It also has a low incidence of complications