Comparison of intra-articular pethidine and neostigmine for postoperative analgesia in patients undergoing knee arthroscopy

Traditionally local anesthetics such as bupivacaine along with systemic analgesics have been used for postoperative analgesia after knee arthroscopy but it has a short duration of action. Recently, neostigmine a cholinestrase inhibitor has shown analgesic actions when used intrathecally but this central delivery of neostigmine is associated with side effects. Same is the case with central actions of pethidine. Both drugs also have a peripheral analgesic effect. The purpose of this study was to compare the peripheral analgesic effects of intra-articular neostigmine and pethidine used separately in patients undergoing knee arthroscopy. Fifty American Society of Anesthesiologist [ASA] class I and II patients, scheduled for diagnostic knee arthroscopy were allocated randomly in two groups. A standard anaesthetic technique was used. No systemic analgesic was administered. At the end of arthroscopy group I received intra-articular neostigmine 500 mg diluted in 30 ml of normal saline and group II received 50 mg pethidine diluted in 30 ml of normal saline. Postoperative analgesia was assessed by Pakistan Coin Pain Scale at 1, 4, 8, 24 and 48 hours. If required, rescue analgesia was given as intravenous Inj. pethidine. Pakistan Coin Pain Scale Scores were lower throughout in the neostigmine group as compared with pethidine group [p < 0.05]. The requirement of rescue analgesia was also lower in neostigmine group as compared to pethidine group [p < 0.05]. Intra-articular administration of 500 mg of neostigmine in patients under going knee arthroscopy has superior analgesic effect as compared to 50 mg of intra-articular pethidine

Comparison of desmopressin [DDAVP] tablet and intranasal spray in the treatment of central diabetes insipidus

Desmoperssin is the drug of choice for treatment of central diabetes insipidus and most commonly it is used as intranasal spray. In this study, efficacy and side effects of oral desmopressin was compared with the intranasal spray. This study was before -after clinical trial on 14 outpatients [9 F, 5 M, age 14 -50 Y] with central diabetes insipidus who had been treated with intranasal spray of desmopressin previously. Weight, pulse rate and blood pressure [sitting -standing], biochemical profile, serum electrolytes, 24h urine volume, specific gravity of urine and LFT was measured before and after 1 month study. Starting dose for each patient was one oral tablet of DDAVP [0.1 mg] per 8 hours. Paired Samples T-Test was used for data analysis. No clinically significant changes were found as regard to weight, pulse rate, blood pressure, blood chemistry, electrolyte and urinalysis. Single reported adverse effect was headache [43%] in tablet group and dyspnea [7%] in spray group. Both dosage forms were able to control diurnal polyuria and nocturnal polyuria. The antidiuretic dose - equivalence ratio for intranasal to oral desmopressin was 1: 18. Spray was superior in terms of rapid onset of action and duration of antidiuretic action in 100% and 78% of cases [not significant], respectively. Tablets were more available and much more easily consumed as reported by patients, in 86% [P=0.0006]. Treatment with tablets offers a good alternative to the intranasal route, especially in patients with chronic rhinitis or common cold and similar conditions

Intrapulmonary route for drug administration: effects on plasma concentrations and blood gases

This work aimed to compare four different methods of endotracheal and bronchial lidocaine administration with respect to the site of administration. Forty-eight patients undergoing elective operations with an anesthetic risk ASA I and II were included in this study. In this study, all other patients received lidocaine under bronchoscopic control through the side channel of bronchoscope either deep endotracheal, into the right main bronchus and into the right lower lobe bronchus. At 10 points of time after drug administration, blood samples were taken for measurements of lidocaine plasma concentration [using high pressure liquid chromatography] and blood gas analysis. Therapeutic blood concentrations [>/ 1.4 mug/ml] could be achieved and toxic blood concentrations [>/ 6 mug/ml] could be avoided with all methods of administration. No significant difference was found between the different methods with regard to peak concentration, time to peak, onset and duration of therapeutic levels or relative bioavailability. A significant decrease in PaO2 to 75% of the baseline was seen with all methods used