Prophylactic use of gabapentin to reduce postoperative nausea and vomiting in patients undergoing diagnostic gynecological laparoscopy

Introduction: Postoperative nausea and vomiting [PONV] occurs in patients during the first 24 hours of the surgery. Many drugs have been used for the prevention and treatment of PONV. In this trial, we used gabapentin to evaluate its prophylactic effect in reducing the severity and incidence of PONV in patients undergoing diagnostic laparoscopic gynecological surgery

Methodology: This, double blind randomized controlled trial, was done in operation theatre complex over a period of six months. 140 patients undergoing diagnostic gynecological laparoscopic surgery were selected. Two groups were formed and 70 patients were recruited in each group using lottery method as method of randomization. Group C [control group] was given placebo medication orally two hours before surgery and group G [gabapentin group] received 600 mg of gabapentin orally two hours before the procedure. Standard general anesthesia technique was used in all patients and incidence and severity of postoperative nausea and vomiting [PONV] was recorded in these patients till 24 hours of laparoscopy

Results: Severity of PONV was graded from mild to severe. There was no PONV in 25 patients [35.7%] in group C and 47 patients [67.1%] in group G. It was mild in severity in 8 patients [11.4%] in group C and 5 patients [7.1%] in group G, moderate in 31 patients [44.3%] in group C and 15 patients[21.4%] in group G and severe PONV was seen in 6 patients [8.6%] in group C and 3 patients [4.3%] in group G [P=0.003]. Postoperative nausea and vomiting within 24 hours after procedure was present in 45 patients [64.3%] in group C and 23 patients [32.9%] in group G. Results were significant between two groups after statistical analysis with p value of 0.001

Conclusion: Administration of 600 mg of gabapentin two hours before diagnostic gynecological laparoscopy decreases the frequency and severity of PONV

Lidocaine 4% spray is better than intracuff lidocaine 2% for reducing the incidence of post-extubation cough in patients undergoing total abdominal hysterectomy

Cough at extubation and postoperative sore throat are common complications in patients receiving general anesthesia with trachea! intubation. Different strategies have been used to reduce these effects. In this double blind controlled trial, we evaluated the effects of lidocaine sprayed onto the larynx and injected into tracheal tube cuff to decrease the incidence of cough at extubation and postoperative sore throat in patients undergoing total abdominal hysterectomy [TAH] under general anesthesia. One hundred women, aged 40-60 years, scheduled for TAH under general anesthesia were included in this randomized double blind prospective study. After induction of general anesthesia, just before tracheal intubation, glottus was sprayed by 4% lidocaine or 0.9% saline through a syringe with 4 ml volume. After tracheal intubation, the tracheal tube cuff was filled with 4 ml of 2% lidocaine solution or 0.9% saline. In this way four groups were formed; spray-cuff group [lidocaine spray and lidocaine in cuff], spray-saline group [lidocaine spray and saline in cuff], saline-cuff group [saline spray and lidocaine in cuff], and saline-saline group [saline spray and saline in cuff], having 25 patients in each groups. The primary outcome was the incidence of cough at extubation. The incidence and severity of sore throat was recorded at 15 min, 60 min and 24 hrs post-extubation using visual analogue scale [VAS, 0=no pain, 10= worst pain imaginable] as a secondary outcome. All patients completed the study. Cough was noted in 20%, 16%, 76%, and 84% of patients in the spray-cuff group, spray-saline group, saline-cuff group and saline-saline group respectively. The spray of lidocaine onto the larynx resulted in decreased incidence of cough at extubation [P value < 0.001]. But the intracuff lidocaine did not show any decrease in the occurrence of cough or reduction in the incidence and severity of sore throat as it remained low in all groups. Use of lidocaine spray onto the larynx resulted in significantly decreased incidence of cough at tracheal extubation in patients undergoing TAH. However, the use of lidocaine into endotracheal tube cuffs had no effect on the incidence of cough or sore throat

External fixation: daily versus weekly pin site care

To determine whether there were any differences in the frequency and severity of pin site infections by performing pin site care daily or once a week. cross sectional descriptive study. This study was carried out at Department of Orthopaedics and Traumatology, Khyber Teaching Hospital, Peshawar during the period from Dec 2011 to Jun 2013. This study included 96 patients who were selected by convenient [non probability] sampling technique. Patients were divided into two groups. The mean infection rate during the study in group 1 was grade I in 16% and grade II in 7%, grade III in 1% versus grade I in 12% and grade II in 5%, grade III in 5% in group 2. No grade IV-VI infections were noted. Antibiotics were prescribed for a mean of 60 days [SD 15] in group 1 and 45 days [SD 30] in group 2. The relative risk [RR] of positive cultures at the proximal pin sites was 1.5 [95% CI 1.2-1.9] No difference was found between the groups. No differences between daily and weekly pin site care were observed as regards the severity of infections, frequency of infection rate, of positive cultures, except in week 6, and in use of antibiotics or analgesics

Radiological evaluation of the stability of crossed-pins versus lateral-pins fixation in displaced supracondylar fractures of humerus

To compare the radiological evaluation of stability of closed reduction of supracondylar fractures of humerus treated by percutaneous two-crossed-pin fixation and 2-lateral pin fixation. Randomized controlled trial. Orthopedic Unit Hayatabad Medical Complex Peshawar, from January 2008 to July 2009. Fifty patients with displaced supracondylar fracture of humerus presented between ages 1-12 year were randomly allocated in two groups of 25 patients each and were subjected to crossed-pin fixation and 2-lateral pin-fixation. Primary outcome measure was determined with the help of Baumann angle. Secondary outcome measure was determined with the help of Metaphyseal-Diaphyseal [MD] angle. Mean age of patients was 7.02 +/- 2.25 year. Mean loss of Baumann angle and Metaphyseal Diaphyseal angles were 5.360 +/- 2.220 and 2.420 +/- 1.250 respectively. The mean Baumann angle loss in the two cross pins fixation group and the 2-lateral pins fixation group were 5.56° +/- 1.80° and 5.16° +/- 2.64° respectively. The mean MD angle loss in the two crossed pins fixation group and the 2-lateral pins fixation group was 2.440 +/- 1.220 and 2.400 +/- 1.230 respectively. When loss of Baumann and Metaphyseal-Diaphyseal angles were compared between two methods of fixation using Student t test, no significant difference in the stability of two methods of pin fixation was observed. Radiological analysis showed that both the techniques were effective in terms of stability

Effect of gabapentin on opioid requirements in patients undergoing total abdominal hysterectomy

Gabapentin possesses antihyperalgesic and antiallodynia properties and has a definite role in neuropathic pain relief. In this study, we tried to determine whether preemptive use of gabapentin can result in reduction of intra and postoperative pain and narcotic [nalbuphine] requirements in patients undergoing total abdominal hysterectomy [TAH]. In this randomized, double-blind controlled trial, 35 patients [study group] undergoing TAH received gabapentin 1200 mg and 35 patients [control group] received placebo orally two hours before induction of anesthesia. Intra-operatively, an increase in blood pressure and heart rate were taken as an indicator of pain during surgery and nalbuphine at 0.05-mg/kg body weight was administered as a rescue analgesia. Postoperatively, for the initial 24 hours, pain was assessed on a Visual Analogue Scale [VAS score 1-10, score 1-3 considered mild pain, 4-7 moderate pain and 8-10 as severe pain]. If score was more than 3 a top up dose of nalbuphine 0.05 mg/kg was administered intravenously. Total nalbuphine consumption during the intraoperative period and initial 24 hours postoperative period was recorded for each patient. Thirty four patients in the gabapentin group [study group] and 35 patients in the Placebo group [control group] completed the study. Overall, pain scores in the gabapentin group were significantly lower as compared to the Placebo group. The total nalbuphine consumption was 13.2 +/- 4.7 mg [mean +/- SD] in the gabapentin group versus 24.3 +/- 9.2 mg in the Placebo group [P < 0.001]. Preemptive use of gabapentin resulted in reduction of intra and postoperative narcotic [Nalbuphine] requirements in patients undergoing total abdominal hysterectomy

Safety of single layer continuous extra mucosal gut anastomosis in emergency

To evaluate the safety and complications of a single layer continuous extra mucosal gut anastomosis in emergency. This descriptive study was conducted in emergency department of Lady Reading Hospital Peshawar over a period of ten months from September 2007 to July 2008. Study comprised of fifty consecutive patients after fulfilling the inclusion and exclusion criteria. The safety of anastomosis technique was analysed by postoperative complications of morbidity and mortility. Among 50 patients 80% were male and 20% were female, mainly young adults. Patients with anastomotic leakage were 8%. The rate of wound infection was 34%. Mean hospital stay was 7.22 days. Mortality was 8% due to septicemia and hypovolemic shock. Single layer continuous extra mucosal anastomosis is safe and with less anastomosis-related morbidity and mortality

Maternal factors associated with intrauterine growth restriction

Intrauterine growth restriction is a major neonatal health issue. Maternal factors have been found to have greater impact on IUGR. Studying these factors can help in reducing the mortality and morbidity associated with IUGR. This Case-control study was conducted at the department of Paediatrics Post-graduate medical institute Lady Reading Hospital Peshawar from March 2008-April 2009. Small-for-gestational age [SGA, i.e., IUGR cases and n=200] live born babies were compared with appropriate-for-gestational age [AGA, i.e., controls and n=200] babies. Information regarding socio-demographics of mothers, gestational age and birth weight of baby, maternal clinical characteristics, and medical and obstetric complications during pregnancy was recorded on a predesigned proforma. Data analysis was done through SPSS-16. To find the maternal factors associated with the intrauterine growth restriction, multivariable logistic regression was used. We also did two different sets of logistic regression analysis for Symmetric and Asymmetric SGA babies as Cases. After adjusting for other variables in the multivariable model we found that the mothers of IUGR babies were of younger age [OR=0.8, CI=0.7-0.9], were poor [OR=2.5, CI=1.4-4.4] and underweight [OR=3.5, CI=1.1-5.7] and had anaemia [OR=2.7, CI=1.3-5.4] in the index pregnancy, and had history of Previous IUGR birth [OR=9.7, CI=3.3-18.3] and placenta previa [OR=3.2, CI=1.1-6.6]. There was an interaction between pregnancy induced hypertension and parity of mother with a primary-para mother with pregnancy induced hypertension [PIH] having an increased risk for IUGR babies [OR=10.1, CI=1.0-23.2]. The studied factors need special attention in hospital based settings in order to improve the perinatal outcome in IUGR babies