ABSTRACT
Background: Labor pain is one of the most intense pains that a woman experiences. Almost 60% of primiparous women described the pain of uterine contractions as unbearable extremely severe or excruciating. Aims: Our study aimed to relieve pain suffering of mother and to decrease fetal acidosis to make the delivery process safer for mother and baby. Settings and Design: Thus, epidural labor analgesia was designed comparing ropivacaine-fentanyl (RF) and bupivacaine-fentanyl (BF) as intermittent bolus technique. Materials and Methods: Sixty women who requested epidural analgesia having ≥3 cm cervical dilatation were allocated in two groups, one group received RF and the other group received BF. Each group received study drug 16 mL with 50 µg fentanyl and top of 10 mL and 25 µg fentanyl when visual analog scale (VAS) ≥3. The efficacy of analgesia, adverse effects, and obstetric and neonatal outcomes were compared. Statistical Analysis: For skewed data or ordered categorical data, nonparametric Mann-Whitney U-test was used for statistical analysis of two groups. For categorical data, comparisons were made by Pearson's Chi-square test or Fisher's exact test as appropriate (%). Results: Both groups were comparable in terms of demographic data and obstetric and neonatal parameters at the onset of labor Comparison of heart rate, systolic blood pressure (BP), diastolic BP, and saturation between Group RF and Group BF. It was found statistically not significant. VAS score before the epidural study drug was given, was 5 (4-5) in RF group, and was 5 (3-6) in BF group, and after 1 min, VAS score was 1 in both the groups thereafter. The score remained zero till at 100 min in both the groups till the time when the top-up dose was given. Bearing down reflex was present in all the patients as judged by the obstetrician. It was sluggish in 20% of patients in Group RF as compared to 10% in Group BF. Conclusions: From clinical and safety perspective, both RF and BF were reasonable choice for labor analgesia.
ABSTRACT
CONTEXT: Students should be exposed to early clinical scenario so that they start developing competency-based learning right from their MBBS 1(st) year. Medical Council of India has recognized this need and has suggested early clinical exposure of MBBS 1(st) year students in their document Vision 2015. Medical education in India needs change for achieving desired competencies. It has been concluded that Indian medical undergraduates have inadequate knowledge in cardiopulmonary resuscitation (CPR). AIMS: To implement CPR workshop in MBBS 1(st) year, and to study the impact of CPR workshop among MBBS 1(st) year students. DESIGN: Interventional study. MATERIALS AND METHODS: CPR workshop was conducted with the help of Faculty of Anesthesia and Physiology among MBBS 1(st) year students. Teaching learning methods employed were lecture, demonstration, and hand-on practice on mannequin in small groups. The evaluation was done by pre- and post-standardized, validated questionnaire; direct observation procedural skill, and feedback questionnaire. RESULTS: There was a significant improvement in knowledge of students as shown from results of pre- and post-questionnaire. About 84.24% students found the presentation excellent, 71.23% students found the demonstration excellent in terms of visibility and clarity, 63.7% students found the instructions excellent. All students were successful in acquiring skills of CPR as shown by results of directly observed procedural skills. CONCLUSIONS: Results of this study suggest that the workshop provided students with sound basic knowledge and adequate practical skills in CPR. CPR workshop should be carried out every year among undergraduate students. CPR workshop should be introduced in MBBS 1(st) year curriculum.
