Comparison of general and spinal anesthesia in patients undergoing open abdominal hernia repair in terms of post-operative pain

Background and Objectives: Abdominal hernioplasty is a very common intervention that can be performed under general or spinal anesthesia. We compared general and spinal anesthesia in patients undergoing open abdominal hernia repair on elective basis

Study Design: Randomized control study

Place of Study: Allied Hospital Faisalabad

Period: September 2017 to December 2017

Methodology: Forty [40] adults received either General Anesthesia with succinylcholine, propofol, nelbuphine and atrarcurium [group A, n=20] or spinal anesthesia [L3-L4] with bupivacaine 0.5% 10mg [group B, n=20]. Then the Hemodynamic data [blood pressure, pulse], pain scores, time to first analgesic and side-effects were recorded of the patients

Results: Among the patients, hernia was supraumbilical in 6, umbilical in 7 and infraumbilical in 7 patients of group A and in 6, 6 and 8 in group B patients, respectively, p value >0.05. Maximum decrease of systolic blood pressure was 10+/-6 in group A and 21+/-6% in group B, p value <0.05 and of heart rate 11+/-5 and 17+/-7%, p value >0.05, respectively. Pain scores at 0, 2, 4 and 8 hours after surgery were: 4 [2-6], 5 [2-7], 5 [1-6] and 4 [2-6] in group A and 0, 0, 0 [0-2] and 1 [0-3] in group B, respectively, p value <0.05. Pain scores at 12 and 24 hours were 4 [1-5] and 3 [0-4] in group A and 2 [0-4] and 1 [0-3] in group B, respectively, p value >0.05. Time to first analgesic was 28+/-10 in group A and 580+/-138 min in group B, p value <0.001. 7 [35%] of the patients in group A and 1 [5%] in group B patients had post-operative nausea and vomiting, p value <0.05

Conclusion: Patients undergoing open ventral hernia repair and received general anesthesia were more stable in terms of blood pressure and heart rate but the patients who received spinal anesthesia had less postoperative pain and less post-operative nausea and vomiting

Post-infective polyneuritis: a record study [2005 - 2009]

Post-infective polyneuritis, also known as Guillain-Barre syndrome [GBS], is a rare and rapidly progressive immune-mediated disorder that consists of inflammation of nerves and usually causes the muscle weakness, sometimes progressing to complete paralysis. This retrospective study was undertaken to assess the incidence, management and outcome of post-infective polyneuritis in District Faisalabad, Pakistan. We reviewed all the 67 cases, 47 males and 20 females, who were admitted to the ICU of the Allied Hospital, Faisalabad during 2005-2009, and diagnosed as post-infective polyneuritis. The management comprised of treatment of the complications of the disease, and the specific therapy with plasmapheresis or high-dose immunoglobulin. Six paediatric cases were also admitted; two of them were found to be suffering from poliomyelitis. Thirteen cases of muscular weakness due to hypokalaemia mimicked the diagnosis of GBS. The specific therapy involving plasmapheresis or immunoglobulin resulted in [i] fewer patients needing mechanical ventilation, [ii] the decreased duration of mechanical ventilation, and [iii] reduction in the time needed for motor recovery and walking without assistance. Early referral to ICU, management of complications, good nursing care and specific therapy with plasmaphresis or immunoglobulin within seven days of onset of the symptoms improve prognosis

Postoperative vomiting after single dose of injection dexamethasone at the time of induction of general anesthesia

To describe the effect of single dose of injection dexamethasone at the time of induction of general anesthesia on post operative vomiting within first 24 hour in Allied hospital Faislabad. This is hospital based prospective comparative study conducted from November 2007 to November 2008 at surgical unit III, Allied /DHQ Hospital Faisalabad. Two groups, cases and controls, were made. Injection dexamethasone was given to the cases group and injection normal saline was given to the controls group at the time of induction of general anaesthesia. The data was entered into a structured proforma separately. Number of episodes of vomiting was recorded within 24 hour postoperatively in each group. Both groups were compared. A total of 90 patients were included in this study. Equal number of cases and control were taken [45 patients in each group]. During the 24-Hour Postoperative observation period, 34% of patients in the dexamethasone group, compared with 63% of patients in the saline group, reported nausea and vomiting [p<0.001]. Injection dexamethasone given at the time of induction of general anesthesia significantly reduces the frequency of post operative vomiting