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Background and Aims: Several studies have attempted to identify patients at risk of developing severe pain after caesarean section (CS) by utilizing preoperative experimental pain application and clinical tests. The three-item questionnaire and reported pain intensity on infiltration of local anesthetic (LA) on the back of patient just before administration of spinal anesthesia, are two simple tests previously shown to be promising. We aimed to study utility of these two tools in Indian patients undergoing CS and find their correlation with postoperative pain and analgesic consumption. Material and Methods: A total of 150 parturients undergoing elective CS were enrolled. Preoperatively patients were asked to rate their level of anxiety, anticipated postoperative pain and analgesic need after surgery (three-item questionnaire). The pain intensity reported by patient upon LA injection for spinal anesthesia were recorded. In the postoperative period, pain intensity at rest, evoked pain and need for rescue analgesics were recorded. The correlation between three item questionnaire and pain on LA infiltration to postoperative pain were evaluated. To see relationship between the predictor variables to outcome, a multiple regression analysis was performed. Results: The predictors variables and postoperative pain were found to have mild correlation (r = 0.124 to 0.239). The predictor variables were significantly correlated with postoperative pain at rest but their association was not significant to evoked pain intensity. Multiple regression analysis showed that change in the predictors explains only 7-8% variance in postoperative pain outcomes. Conclusion: The three -item questionnaire and pain intensity reported upon LA infiltration for spinal anesthesia have mild correlation to postoperative pain in Indian parturients undergoing CS. As these variables predicts only 8% variance in pain experienced after CS, further studies are required for accurate prediction and targeted treatment of post CS pain.
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OBJECTIVES: Thyroid hormones regulate metabolism and homeostasis, and variations in thyroid hormone levels are common in chronically ill patients. Thyroid dysfunction, especially in critically ill patients admitted to the intensive care unit (ICU), is associated with adverse outcomes. This study was conducted to find a correlation between thyroid profile and sepsis and associate it with the acute physiology and chronic health evaluation II (APACHE II) score. BACKGROUND: :A cross-sectional study was conducted from January 2015 to December 2015 at the Department of Medicine, KLES Dr. Prabhakar Kore Hospital and Medical Research Center, Belagavi. A total of 100 patients aged 18 years or more fulfilling the sepsis criteria were included in the study. Patients were subjected to clinical examination followed by systemic examination. The clinical severity as well as the prediction of outcome was assessed by APACHE II score. Based on the outcome, the patients were divided into two groups, namely survivors and nonsurvivors. The data obtained were coded and entered into Microsoft excel spreadsheet and analyzed using SPSS 21. Continuous data were compared using independent sample t-test. The correlation of free triiodothyroxine (fT3), free thyroxine (fT4), and thyroid-stimulating hormone (TSH) with APACHE II score was done using Pearson's correlation coefficient. At 95% confidence interval, p < 0.05 was considered as statistically significant. BACKGROUND: Out of 100 patients, 57 patients were men and 43 were women. The mean age of patients was 48.55 ± 18.09 years. Type 2 diabetes mellitus was the most common29 comorbid condition. Pneumonia was the primary diagnosis noted in 31patients followed by pyelonephritis.20 Most18 of the patients had APACHE II scores between 15 and 19. The mean APACHE II score was higher in nonsurvivors as compared to survivors (30.5 ± 7.24 vs. 16.92 ± 8.11; p < 0.001). In the study, 68 patients survived, while 32 of them died. Among nonsurvivors, APACHE II was inversely correlated with fT3 and fT4 levels, while TSH was positively correlated. BACKGROUND: In ICU patients with sepsis, thyroid profile in combination with the APACHE II score may prove to be a better indicator of ICU morbidity and mortality more accurately than the APACHE II score alone.
