Intrathecal tramadol as an adjuvant in subarachnoid block to prolong the duration of analgesia

Objective: To assess the effect of intrathecal tramadol added to bupivacaine to prolong the duration of analgesia in subarachnoid block for lower limb orthopedic surgeries

Study Design: Randomized controlled trial

Place and Duration of Study: Anesthesia department of Combined Military Hospital Sialkot, from Nov 2015 to Apr 2016

Material and Methods: Patients were selected by non-probability consecutive sampling. One hundred and fifty patients from American Society of Anesthesiologists [ASA] I, II and III category fulfilling inclusion criteria undergoing various lower limb orthopedic surgeries were divided into two groups by lottery system. Group tramadol bupivacaine [TB] received 25mg [1 ml] of tramadol plus 2ml [10mg] of 0.5% bupivacaine while group bupivacaine alone [SB] received 1 ml normal saline plus 2ml [10mg] of 0.5% bupivacaine. Time to first analgesia request was noted as a measure of duration of analgesia. Time of onset of sensory block level and peak sensory block level and time to reach the peak sensory block level were also noted. Quality of anesthesia was compared among two groups. Data were analyzed by using SPSS version 22

Results: Four patients were excluded from the study. The duration of anesthesia was effectively prolonged in group TB 181.56 +/- 12.42 mins as compared to group SB 120.93 +/- 15.54 mins. VAS score was significantly lower in group TB. Higher peak sensory block levels [T6] were achieved in group TB as compared to group SB. However time to reach the peak sensory block levels were significantly longer in group TB. [4.5 +/- 0.47mins vs 3.09 +/- 0.54 mins]

Conclusion: This study showed that intrathecal tramadol [25mg] can safely be used along with bupivacaine in subarachnoid blockade to prolong the duration of analgesia and improve the quality of anesthesia as well

Neglected monteggia fracture: experience in eleven patients

To evaluate surgical options in the treatment of missed monteggia fracture dislocation. Case series Place and Duration of the Study: CMH Rawalpindi from May 2007 to August 2009. We have presented our surgical experience in 11 patients who reported to CMH Rwp from May 2007 to August 2009. They were treated by close reduction or surgically depending upon the patient age and delay. Boyd's approach was used for open reduction of the radial head in some cases. Postoperatively they were evaluated by Kim's elbow performance score Patients were all boys. Those below 12 years of age were included in the study. Excellent to good results were observed in those who were treated by open reduction of ulnar fracture by callus trimming with indirect reduction of radial head via interosseous membrane traction. Single forearm bone fracture should be treated as fracture dislocation until proved by adequate radiological survey and clinical examination

hernia which repair? experience with pre-peritoneal Stoppa's repair

The objective is to evaluate an alternate hernia repair technique for complex, combined primary and recurrent groin hernias. Quasi - experimental study. Surgical unit II, Ward - III CMH Rawalpindi from Jan 2002 to Jan 2005. This study included forty patients having inguinal hernias with 31 to 70 years of age. Twenty patients having primary bilateral, 10 cases with recurrent hernia and 10 with complex hernias. Mean hospital stay ranged from 1-5 days with average 3 days. General anaesthesia was administered in 35 cases and spinal anaesthesia only in 5 cases. Mean operation time was 70 minutes [Range 45-110 min]. Recurrence was noted only in one case. There was no need of conversion to another technique where as no case had mesh infection. Minor wound complications such as seroma or erythema were noted in few cases without any peri operative death. Stoppa`s repair is safe, effective addition to surgeons armamentarium to treat complex, groin hernias. It provides facility for repair to three critical areas, such as direct, indirect and femoral hernia

Early postoperative complications of Stoppa's repair

To evaluate early postoperative complications of Stoppa's properitoneal mesh repair for bilateral inguinal hernia/recurrent hernia. A prospective, non-randomized interventional and comparative study. This study was carried out at Combined Military Hospital Rawalpindi from June 2002 to October 2003. A total of 30 patients who underwent hernial repair were included in this study. All patients were males with ages ranged from 40-65 years [mean age was 54 years]. Eight patients [27%] had primary bilateral inguinal hernia and sixteen [53%] had a unilateral recurrent hernia and contralateral primary hernia. Six [20%] had a bilateral inguinal hernial repair with unilateral recurrence. The Stoppa's repair is a worth while method of inguinal hernial repair

Effect of topical glyceryl trinitrate on the management of acute anal fissure

To find out the effect of topical glyceryl trinitrate on the symptoms and signs of acute anal fissure. Seventy-five patients were treated with 0.2% topical glyceryl trinitrate twice daily as local application in the anal canal with the help of cotton pledget, which was soaked in the ointment for four weeks and their symptomatology, and healing of anal fissure was assessed weekly. The study was carried out at a surgical unit of Combined Military Hospital Rawalpindi for six months from June 2004 to December 2004. Out of 75 patients, 42 had complete healing of anal fissure while six had partial healing. Thus the healing rate was 64% observed in our study. 0.2% Glyceryl trinitrate ointment is an effective way of treating acute anal fissure