Effectiveness Of Intrathecal Dexmedetomidine In Combination With Hyperbaric Bupivacaine For Lower Abdominal Surgeries And Its Postoperative Analgesic Characteristic.

Background: Intra-thecal anaesthesia is the commonly preferred, block for surgeries of lower abdomen, perineal and lower limb. It is easy to administer and very economical but needs skills. Intrathecal use of local anaesthetics possesses a short duration of action and needs early use of rescue analgesia postoperatively. Objective was to assess the efficacy of Dexmedetomidine in adjuvant with bupivacaine for neuraxial anaesthesia and postoperative analgesic characteristics. It was a prospective comparative study, conducted at Anaesthesia Department, Liaquat National Hospital, Karachi from January to July 2020. Methods: Overall 100 patients conveniently recruited who underwent lower abdominal procedures were allocated into two groups by randomization, i.e., 50 in each group and were labelled as Group N and Group D10. Group N consist of 0.5% bupivacaine 10 mg (2 ml) + diluted with 0.5ml normal saline dilution and group D10 consist of 10 µg Dexmedetomidine + 0.5% bupivacaine 10 mg (2 ml) with 0.5 ml normal saline dilution, total 2.5 ml dose in each group. The duration of block and regression was evaluated. . Results: The study showed significant differences in sensory and motor block to reach T10 and Bromage 3 respectively. Patients who were assigned in Group D reported short onset of sensory to reach T10 (5.4±1.17) and motor to reach Bromage 3 (10.4±1.03) as compared to Group N (9.9±2.12 and 17±22) respectively. Participants of Group D required rescue analgesia in less amount throughout intervals as compare to group N. Conclusion: The usage of 10ug Dexmedetomidine adjuvant with 0.5% bupivacaine significantly reduced the onset on sensory T10 and motor Bromage 3 and also prolong duration of sensory and motor regression, moreover minimal adverse effects and less use of rescue analgesic drugs were observed.

Double blind, randomised trial to compare efficacy of escitalopram versus citalopram for interferon induced depression in hepatitis C patients.

OBJECTIVES: The objective of the study was to compare the two antidepressant drugs citalopram and escitalopram on the basis of efficacy in depressed patients of Hepatitis C patients receiving interferons. METHODS: In this double blind randomized trial, the hepatitis C patients visited National institute of liver and Gastro intestinal diseases (NILGID), Dow University Hospital, were screened for depression before starting treatment with interferons. The Institutional review board approval was obtained and its letter reference no.is: IRB-682/DUHS/Approval/2016/169. Patients with previous history of depression were excluded from the study. The patients who started with Interferon therapy were assessed for depression on baseline and then on each visit. Those who developed depression were randomly assigned to receive either citalopram or escitalopram. Treatment groups were assessed with depression scale each time they visit the clinic. Two antidepressants were compared for their efficacy at an interval of 4 weeks, 8weeks and then 12 weeks. RESULTS: In the current study 80 patients were randomized to receive either citalopram or escitalopram. The study outcome was better in patients treated with escitalopram. The mean change in depression score from baseline to the end of the study was greater in escitalopram group i.e. 10.41 as compared to citalopram group i.e. 14.17. The difference in depression score was also calculated as 4.28 and.3.76 (p < 0.001) for both the drugs at week 8 and week 12 respectively, which was statistically significant. Difference in depression score were also calculated for gender 0.576 (p = 0.497) and age 0.950 (p = 0.265), which were found to be non-significant, statistically. CONCLUSION: The results demonstrated superiority of escitalopram over citalopram, the drug is twice as potent as the racemic mixture. Additionally the drug is well tolerated and exhibited better effects. Escitalopram proved to be a safer alternative to citalopram.