Cancer arises from the transformation of normal cells into tumor cells in a multistage process that generally progresses from a pre-cancerous lesion to a malignant tumor (Davis et al., 1964). The aim of the study is to find out reason, which can increases various risk factors of breast cancer among reason of Pakistani women. Materials and Methods:A total 100 subjects were divided into two groups, 50 subjects in each group. Subjects were interviewed using a specifically designed questionnaire. Subsequent disease-specific mortality was also measured. Results:In this study, the total 50 sample patients different mean age of the patients is divided into two group 16 -40 (n=25) and 41 -75 (n=25) years. Most of the patients have high grade tumor is Provisional Grade II (32.0%), Ductal Carcinoma Grade III 11(22.0%), Fibro-adenoma 10 (20.0%), Carcinoma 7 (14.0 %), benign breast disease 2 (4.0%), giant fibroadenoma1 (2.0%), Tubular Adenoma Right breast 1 (2.0%) and consistent with fibro-adenoma 1 (2.0%). The analysis was study the different types of breast cancer in different age groups. Most frequent categories were Ductal Carcinoma Grade III (22.0%) and Provisional Grade II (32.0%). Conclusions:Pakistani women are at the highest incident rate (about 32.0%) for breast cancer is diagnosed in stages III and IV. Moreover various risk factors including age, breast-feeding, physical activity and menopausal status were significantly associated with increased risk of developing breast cancer in Pakistani women (Bernstein L, 2002). Women in Pakistan do not know much about that breast cancer is the curable disease. There is strong evidence women that lack of education and low income contribute significantly along with various other factors. We know that breast cancer prevention is in an early diagnosis. When disease is detected early, patient can almost be cured without mutilating surgery like mastectomy, leaving women with less psychological morbidity.
Aim: To compare the mean time for first rescue analgesia after preemptive gabapentin versus paracetamol for pain control after tonsillectomy in children. Method: This random controlled trial was conducted by Anesthesia team in ENT OT in Jinnah Hospital, Lahore from January 1, 2018 to June 30, 2018. After taking informed consent, 60 patients fulfilling the selection criteria were recruited and after obtaining demographic information, two groups were formed using lottery method Group G and Group P each having 30 patients. Patients were given oral Paracetamol 20 mg/kg and oral Gabapentin 10 mg/kg 120 minutes before induction of anesthesia in Group P and Group G respectively. Post-operatively, patients’ pain was monitored with VAS after every 30 minutes. When VAS exceeded 3, it marked the demand of first post-operative rescue analgesia was given and time was noted. Injection Ketorolac 0.5mg/kg was given as rescue analgesia. Mean time of first rescue analgesia was compared in between 2 groups via SPSS 19 Results: There were no significant differences for variables such as age and BMI in between two groups. The main result of study is that mean time for first rescue analgesia in group G and group P found to be 468.00± 57.14 & 377.00±51.47 minutes respectively. The calculated p-value was P < 0.0001 proving significant difference in duration for first analgesia in between two groups. Conclusion: There is significant difference in mean time for first rescue analgesia after preemptive gabapentin versus paracetamol for pain control after tonsillectomy in children. Keywords: Preemptive Analgesia, Gabapentine, Paracetamol, Post-operative pain control
Introduction: For upper-limb orthopaedic surgery, supraclavicular brachial plexus block is routinely used and involves administering bupivacaine to the supraclavicular plexus. Recent studies claimed that the addition of dexmedetomidine to bupivacaine for supraclavicular brachial plexus block significantly prolonged the mean duration of postoperative analgesia. This study was necessitated by the fact that existing evidence was limited and there was no local published material to support the findings. Objective: The objective of this study was to compare the postoperative duration of analgesia in patients receiving supraclavicular brachial plexus for upper limb surgeries block with and without dexmedetomidine. Methods: This study was performed at the Department of Anesthesiology Lahore General Hospital, Lahore using randomized controlled trial. In this study, sixty patients between the ages of 18 and 60 and from both genders who underwent ultrasound-guided supraclavicular brachial plexus block for upper limb orthopedic surgery were randomly and equally divided into two treatment groups. The patients of Group-A received bupivacaine along with dexmedetomidine while those in Group-B received bupivacaine with normal saline for the block. Mean postoperative analgesia duration in minutes up to a VAS > 3 was the outcome variable. Each patient signed informed consent before the study. Results: The patients' average age was 38.4±14.1 years and 37 (61.7%) were male and 23 (38.3%) were female. The significantly longer mean duration of postoperative analgesia (754.27±144.89 vs. 441.80±111.38 minutes with p-value less than 0.001) was observed in patients receiving dexmedetomidine in addition to bupivacaine as compared to bupivacaine alone. This significant mean duration was also recorded in various subgroups of age, gender, BMI, and duration of surgery. Conclusion: The superiority of the combination of dexmedetomidine with bupivacaine was reported as compared to the conventional practice of bupivacaine alone in terms of significantly prolonged mean duration of postoperative analgesia. This novel combination may reduce the need for postoperative opioids and recommend it for future anesthetic practice. Keywords: Supraclavicular Brachial Plexus Block, Dexmedetomidine, Post-Operative Analgesia
Objective: The aim of current study is to determine the effectiveness of caudal bupivacaine and bupivacaine-tramadol combination for postoperative analgesia in children undergoing lower abdominal surgeries. Study Design: Randomized Control trial Place and Duration: Department of Anesthesiology Surgical ICU & Pain Management Ghulam Muhammad Mahar Medical College, Sukkur and Lahore General Hospital, Lahore, during the period from March 2021 to August 2021. Methods: There were 110 children of both genders with ages 2-8 years undergoing lower abdominal surgery were included in this study. A detailed demographics of enrolled patients, including age, sex, and weight were computed after obtaining informed written consent from each individual. Patients were equally divided in two groups. Group I had 55 patients and received combination of tramadol (1 mg/kg) and bupivacaine (0.5 ml/kg of 0.25%) and group II received only bupivacaine 0.5 ml/kg of 0.25% after induction of anesthesia in caudal epidural space. Post-operatively pain score, requirement of rescue analgesia and sedation score was assessed and compared among both groups. SPSS 24.0 was used to analyze complete data. Results: There majority males 35 (63.6%) in group I and 32 (58.2%) in group II. In group I mean age of the patients was 5.9±4.61 years and in group II mean age were 4.8±9.44 years. Mean weight of the patients in group I was 17.6±4.52 kg and in group II mean weight was 19.5±7.34 kg. During the first 24 hours, we noticed a reduced pain score in the bupivacaine–tramadol group. When it comes to postoperative analgesia, the bupivacaine-tramadol group had much longer analgesia durations and a significantly lower need for rescue analgesia with p value <0.003. Postoperative frequency of adverse effects in group II was greater found in 4 (7.3%) cases as compared to group I in 1 (1.8%) patients. Conclusion: In children having abdominal surgery, we found that caudal tramadol with bupivacaine provided more extended and better quality postoperative analgesia than plain bupivacaine. Keywords: Tramadol, Bupivacaine, Abdominal Surgery, Pain Score, Rescue Analgesia
Background: Combined spinal-epidural (CSE) anesthesia is a novel technique that decreases the amount of anesthetic required yet with greater anesthetic effect compared to spinal or epidural anesthesia alone. Recent studies showed that epidural volume extension (EVE) with saline further increased the anesthetic effect of this combined approach resulting in longer two-segment regression time. However, literature was scarce in the local context that provides the basis of the present study. Aim: The study focuses on the comparison between the mean duration of two-segment regression time in patients who underwent lower limb surgery treated with CSE and CSE plus EVE with saline. Methods: It was a randomized controlled trial and included 60 patients of both genders who range between 20-60 years. They belong to ASA class I and II and underwent lower limb trauma surgery with CSE anesthesia which were further randomly divided into two treatments groups. The patients of Group-A received EVE in addition to standard CSE while Group-B received standard CSE alone. The outcome variable was the mean two-segment regression time which was compared in these two groups. Results: Mean age of selected patients was 35.75±10.60 years. Study included 35 (58.3%) male and 25 (41.7%) female patients. The mean duration of surgery was 79.65±12.92 minutes while the mean BMI was 27.78±3.25 Kg/m2. Nineteen (31.7%) patients were from ASA Class-I and 41 (68.3%) patients associated with ASA Class-II. The mean two-segment regression time was substantially longer in the CSE plus EVE group as compared to the group receiving CSE alone (83.77±7.56 vs. 59.97±6.22 minutes; p-value<0.001). In these two groups, a statistically important difference was also noted across subgroups based on the age of the patient, gender, BMI, duration of surgery, history of diabetes and ASA status. Conclusion: CSE anesthesia with EVE proved its superiority over the conventional practice of CSE alone in terms of longer mean two-segment regression time in patients with lower limb trauma surgery. Keywords: Combined Spinal-Epidural Anesthesia, Epidural Volume Extension, Two-segment Regression Time
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