Post-operative Analgesic and Opioid-sparing Effect of a Single-dose Pre-operative Oral Pregabalin in Gynaecological Surgeries.

Background: Post-operative pain treatment is a major challenge in our environment. Opioids may cause respiratory depression post-operatively. Therefore, any combination of opioid and non-opioid analgesics that provides quality post-operative pain control and reduces opioid consumption with its attendant side effects will be highly desirable. Objectives: The aim of this article is to evaluate analgesic benefits and opioid-sparing effects of pre-operative oral pregabalin in patients who undergo abdominal gynaecological surgeries. Materials and Methods: A prospective randomized double-blind placebo-controlled study is carried out at University of Ilorin Teaching Hospital, Kwara State, Nigeria. Eighty-two patients scheduled for gynaecological surgeries were randomized into two equal groups. The patients in the control and study groups received a placebo drug and oral pregabalin 150 mg, respectively, 1 h before induction of general anaesthesia. Post-operative pain intensity using a five-point Verbal Rating Scale, time to first request for analgesia, and 24 h post-operative pethidine consumptions were assessed. Mean values were compared using Student's t-test. Categorical data were compared with the χ 2 test. Level of significance was set at 5% (0.05) and power of the study was 80%. Results: Demographic characteristics were comparable between the two groups. The median pain score was 0-2 (no pain-moderate pain) throughout the study. Post-operative static and dynamic pain scores at 1, 4, and 12 h were significantly higher in the placebo group (<0.001). Twenty-four hours post-operatively, there were no significant differences in static and dynamic pain scores between the two groups (P=0.131 and P=0.384, respectively). Time to first analgesic requirement and total pethidine consumed within 24 h post-operative were 47 ± 19 vs. 258 ± 137 min (P=0.001) and 326.19 ± 62.70 vs. 192.86 ± 55.84 mg (P=0.001) in the control and study groups, respectively. The pre-operative use of pregabalin reduced post-operative opioid requirement by 40.9% in the study group. Nausea and vomiting were more common in the placebo group, whereas dizziness, blurring of vision, and sedation were more common in the pregabalin group. Conclusion: A single pre-operative dose of 150 mg oral pregabalin had significantly greater analgesic effects compared with placebo and reduced post-operative opioid requirements in patients undergoing myomectomy or total abdominal hysterectomy. It should be considered an adjuvant in multimodal pain management regimens following gynaecological surgeries.

Effect of spinal anesthesia on QT interval: Comparative study of severe pre-eclamptic and normotensive parturients undergoing cesarean section.

Aim: This study aimed to compare the effect of spinal anesthesia on QT interval in severe pre-eclamptic and normotensive parturients who underwent cesarean section in a Nigerian tertiary hospital. Patients and Methods: Twelve-lead electrocardiogram (ECG) was obtained before, and at intervals after spinal anaesthesia on fifty severe pre-eclamptic (Group A) and fifty normotensive parturients (Group B) who underwent caesarean section. The effect of spinal anaesthesia on QT interval was compared. Results: The preoperative (baseline) mean QT interval was longer in group A than in group B; 453.10 ± 34.11 ms versus 399 ± 18.79 ms, P < 0.001. The prevalence of prolonged QT interval in the severe pre-eclamptic group before spinal anesthesia was 80% while in the normotensive group it was 0%, P < 0.001. At 5, 30, 60, and 120 min after the establishment of spinal anesthesia, the mean QT interval in the severe pre-eclamptic group was shortened and maintained within normal limits; 414.74 ± 28.05, 418.28 ± 30.95, 411.18 ± 19.21 and 401.36 ± 17.52 ms with P < 0.001 throughout. In the normotensive group, there was no significant change in the mean QT interval. Conclusions: This study demonstrated that the QT interval was more prolonged among the severe pre-eclamptic parturients. Spinal anesthesia using 0.5% hyperbaric bupivacaine normalized the QT interval and maintained it within normal limits during the study period.

Acute Oxygen Therapy on Hospital Wards in Low Middle-Income Country: Experience from a Referral Centre in Ilorin, Nigeria.

BACKGROUND: Oxygen is like any other medication that can cause severe consequences if administered inappropriately. OBJECTIVE: To audit the pattern of acute oxygen therapy on regular hospital wards of a referral centre in Ilorin, Nigeria. METHODS: We reviewed 150 patients that received or had a prescription for acute oxygen therapy in three months and extracted relevant information using a proforma. RESULTS: About one-third of the patients (30%) were >65 years of age and the male to female ratio was 1:1. The commonest indication and medical condition for acute oxygen administration were hypoxemia (70.7%) and pneumonia (26.0%), respectively. Pneumonia accounted for most (41.2 %) of the oxygen therapy in childhood. The majority of patients (88.0%) had written order for oxygen prescription, 40.7% had a prescription to target oxygen saturation and only 31.3% achieved their target saturation. Oxygen prescription was adequate (documentation of delivery device, flow rate of oxygen, and target oxygen saturations) in 40.7% of patients. The assessment, monitoring and titration of oxygen therapy were adequate in 92.7%, 65.3% and 28 % of patients respectively. Overall mortality was 27.3% in patients receiving acute oxygen supplementation. Eleven patients had unstable COPD, and 63.6 %, 54.5 % and 45.6 % of them had adequate oxygen prescription, monitoring and titration respectively. The challenges to oxygen use were faulty delivery devices, emptied oxygen cylinders, inability to routinely do arterial blood gas analysis and lack of hospital oxygen protocol. CONCLUSION: The current practice of acute oxygen therapy is not satisfactory and interventions are advocated to improve the healthcare providers' administration of oxygen.

Outcomes of intensive care management of traumatic brain injury in a resource-challenged tertiary health centre.

BACKGROUND: Improved surgical care and protocol-driven intensive care interventions for head injured patients have contributed to the overall reduction in mortality in developed countries. The aim of this study is to highlight the clinical outcomes of patients with severe traumatic brain injury managed in the multispecialty ICU of our institution. STUDY DESIGN: The medical records of all patients with severe TBI managed in our 3-bedded non-dedicated ICU over a 24-month period were reviewed. Data on demographic characteristics, mechanism of injury, neuroimaging and interventions were obtained and the primary outcome measure was the mortality. RESULTS: Fifty one patients, age ranged from 2-75 years and median age of 30 years were studied. The male sex was more involved (M;F of 12;1) and motorcycle crashes caused the majority of the injury (19,{37%}). None of the patients received pre-hospital care and about half (25 {49 %}) presented six hours post trauma. Cranial CT scan showed intracranial haemorrhage in 7 of the 21 patients stabled for neuroimaging. Overall mortality was 70%, with highest mortality recorded in those who did not have post injury brain CT scan (58% vs 82%, p = 0.066). CONCLUSION: Mortality from severe TBI is very high in our environment where routine pre-hospital care and prompt transfer to neurosurgical centres are not practiced. Lack of facilities for monitoring intracranial pressure and arterial blood gases in our ICU also contributed to the high mortality.