Comparison Between Efficacy of Oral Melatonin and Oral L-theanine in Improving Sleep in Cancer Patients Suffering From Insomnia: A Randomised Double-blinded Placebo-controlled Study.

Objectives: The primary objective was to compare the hypnotic efficacy of oral melatonin, oral L-theanine, and placebo in improving sleep in cancer patients with insomnia by the Athens Insomnia Scale (AIS). The secondary objective was to know the prevalence of insomnia in patients with cancer. Materials and Methods: A prospective, double-blinded, placebo-controlled study was conducted after obtaining Institutional Ethics Committee approval. One hundred and twenty patients were randomly assigned to either Group A (melatonin), Group B (L-theanine), or Group C (placebo). They were instructed to take the tablets for 14 consecutive days, two h (hours) before bedtime, and evaluated with AIS on the 1st day, 7th day, and 14th day. Results: There were seven dropouts: Two in Group A, two in Group B, and three in Group C. Significant differences in favour of melatonin treatment were found. There were statistically significant improvements in insomnia in cancer patients on melatonin intake compared to L-theanine. L-theanine had statistically significant improvements in insomnia in comparison to placebo. The mean ± standard deviation AIS on day one in Group A was 14.82 ± 1.29; on day seven was 10.92 ± 1.12; and on day 14 was 5.00 ± 0.70. Similarly, in Group B, the mean ± standard deviation AIS was 15.39 ± 1.03, 13.05 ± 1.06, and 9.55 ± 1.01, and in Group C, the mean AIS was 14.92 ± 1.40, 14.54 ± 1.35 and 13.05 ± 1.61 on the 1st, 7th and 10th day, respectively. There was an improvement in sleep from 1 to 7 days, 7 days to 14 days, and 1 day to 14 days in all the groups (P < 0.005). Conclusion: The hypnotic efficacy of oral melatonin 3 mg was better than oral L-theanine 200 mg in cancer patients having insomnia. Furthermore, L-theanine had a better hypnotic efficacy when compared to a placebo.

The efficacy of paravertebral block evaluated by pain-related biomarkers and reactive oxygen species (ROS) following surgery for breast cancer: A randomized controlled study.

Background and Aims: Paravertebral block has been found to be a recommended method of analgesia for breast surgeries. We aimed to assess the efficacy of paravertebral block compared to morphine by means of the visual analogue scale (VAS), pain-related biomarkers, and reactive oxygen species (ROS) in adult patients undergoing breast cancer surgeries under general anesthesia. Methodology: Forty patients undergoing breast surgery with or without lymph outcome were randomly divided into two groups. Group M received general anesthesia with intraoperative injection morphine (0.1 mg/kg) and group P received general anesthesia with paravertebral block with 0.25% bupivacaine (0.3 ml/kg). The primary objective was to compare the postoperative pain using VAS at baseline, 2 hours, 24 hours, and 48 hours. Secondary objectives were to compare the levels of pain-related biomarkers and ROS in both the groups at baseline, 24 hours, and 48 hours and to study the correlation between the VAS and level of pain-related biomarkers and ROS. Results: There was no significant difference in the postoperative VAS scores in both the groups (P = 0.252, 0.548, 0.488 at baseline, 24 hours, and 48 hours, respectively) and no significant difference in the mean biomarkers in both the groups. The mean VAS negatively correlated with biomarker levels at 24 hours and 48 hours, but the change in VAS after 24 hours and 48 hours did not significantly correlate with the change in the biomarkers. Conclusion: Paravertebral block is equally efficacious to intraoperative morphine for breast surgeries for postoperative analgesia. The biomarker levels were not significantly different when patients received paravertebral block or morphine.

Recent advances in perioperative blood management.

Transfusion of blood and blood products has many adverse effects and should be done only if patient benefits outweigh the associated risks. Current understanding of blood transfusion has improved dramatically, revolutionising the care of surgical, trauma, obstetric and critically ill patients. Most guidelines advise a restrictive approach for stable patients with non-haemorrhagic anaemia for red blood cell transfusion. The rationale for red blood cell transfusion has historically been to improve oxygen transport capacity and consumption-related parameters in anaemic patients. Current understanding casts serious doubts about the true potential of red blood cell transfusions to improve these factors. There may not be any benefit from blood transfusion beyond a haemoglobin threshold of 7 g/dL. In fact, liberal transfusion may be associated with higher complications. Guideline-based transfusion policy should be adopted for the administration of all blood products including fresh frozen plasma, platelet concentrates and cryoprecipitate etc. This should be integrated with clinical judgement.

Comparison of standard weight-based and thenar eminence dimension-based selection of I-gel in pediatric patients - A randomized controlled study.

Background and Aim: Supraglottic airway devices are increasingly being used for airway management. I-gel is being widely used even for pediatric patients. Although the weight-based selection of the size of the device seems to be the standard technique, this method may not be possible in all patients. The aim of the study was to compare the standard weight-based method with the thenar eminence dimension-based method for I-gel selection. Material and Methods: A prospective randomized study was conducted on 74 pediatric patients of either sex, aged between 6 months and 15 years, belonging to American Society of Anesthesiologists (ASA) physical status I, II, and III and who were posted for various surgical procedures under general anesthesia. The study population was divided into two groups of 37 patients each. I-gel was inserted based on weight in group A patients and based on thenar eminence size in group B patients. Parameters like first attempt success rate, ease of insertion, and complications were compared between the two groups using Student's t-test and Chi-square test. Results: The demographic values between the groups were comparable. The first attempt success rate was 97.4% in group A and 91.7% in group B (P = 0.358). Insertion of I-gel was unsuccessful in two patients in group B. Two patients of group B had blood staining of the device. None of the patients had complications related to insertion. Conclusion: The thenar eminence dimension can be used instead of weight while choosing the size of I-gel in pediatric patients. None of the patients had complications related to device insertion.

Prevalence, distribution and correlates of pain in patients with mucormycosis-A cross-sectional study.

Context: COVID-19 has led to a spate of rhino-orbital-cerebral mucormycosis cases in India, the epidemiology of which was least understood before. Only a few case series and case reports discuss the symptomatology of mucormycosis. Aims: The primary objective of our study was to estimate the prevalence of pain in patients with mucormycosis. The secondary objectives include the type, regional distribution, characteristics and determinants of pain in patients with mucormycosis. Settings and Design: A cross-sectional study was conducted on consecutive adult patients with mucormycosis in our hospital. Materials and Methods: Following recruitment, a preplanned written questionnaire that was tested for validity with peers, with closed-ended queries was filled on a sole visit by an anesthesia postgraduate based on the response by the patient. Statistical analysis used: Categorical variables were summarized as proportion and percentage. To compare quantitative variables, Chi-square test was used. Results: A total of 69 out of the 80 patients recruited complained of pain (P value = 0.468). A total of 76.8% of patients had pain in the supraorbital region with 84% of the patients complaining of throbbing pain and 98.6% needing analgesics. Gender, pre-existing diabetes mellitus, organs affected due to mucormycosis, prior steroid usage, prior COVID illness, surgical intervention, and previous experience of pain in the same region had no influence on the presence or severity of pain. Conclusions: Pain is one of the presenting symptoms in patients with mucormycosis which is usually in the supraorbital and maxillary region, nociceptive type and throbbing in nature, and moderate to severe in intensity usually managed with simple analgesics.

Morphine Versus Loperamide with Intrasite Gel in the Treatment of Painful Dermal Ulcers: A Randomized, Crossover Study.

BACKGROUND: Topical morphine along with intrasite gel has been proven to be a simple and effective method to relieve pain. However, morphine is still not freely available in developing countries due to drug restrictions and stringent laws governing it. Loperamide has been reported to relieve pain caused by stomatitis effectively when given topically. Loperamide, being an mu receptor agonist with no systemic absorption, can serve a dual purpose here. Also loperamide being freely available as an over-the-counter drug can be a surrogate drug for topical application. OBJECTIVES: The primary aim was to compare the efficacy of loperamide and morphine in treating pain when applied topically along with intrasite gel. STUDY DESIGN: Adult patients with healthy wounds with pain on Numeric Rating Scale (NRS-11) greater than 5 with no systemic comorbid illness were divided randomly into 2 groups - group morphine or group loperamide - for 24 hours followed by a 1-day washout and crossover in the other group for 24 hours. Pain was assessed once every day. SETTING: Medical college and hospital. METHODS: The parameters assessed included: (1) characteristics of the ulcer; (2) pain was assessed by NRS-11 at 12-hour intervals for a period of 72 hours; and (3) patient satisfaction. Statistical analysis used repeated measures analysis of variance to measure change in mean NRS-11 within each group. Analysis of covariance was used to compare the mean change in NRS-11 in the 2 groups. RESULTS: Morphine and loperamide were equivocal in pain relief after 12 and 24 hours (P = 0.400 and P = 0.753); however, the patient satisfaction scores were better in the morphine group. LIMITATIONS: The earlier studies performed used injectable forms of morphine, for the sake of comparison, we used powdered morphine and powdered Loperamide diluted with saline. Confounding variables include ulcer size and aetiology, which can be a source of bias. The ulcer size was not standardized due to the paucity of sample to study. Equianalgesic doses of loperamide and morphine could not be found even after an extensive literature search. The loperamide dose used in our case was equal to the dose used orally since the same dose appears effective across a range of oral opioid analgesics. The morphine dose was standardized as 10 mg based on a mixture previously used to treat pain due to epidermolysis bullosa. CONCLUSIONS: Topical loperamide can be an efficacious and novel intervention to treat painful ulcers while avoiding systemic effects.