Introduction The adequate management of thoracic trauma requires a systematic approach including pain control, respiratory therapy, and mobility achieved by surgical fixation. Failure to achieve pain control prolongs hospital stay. There are several options for achieving analgesia including epidural catheters, intravenous narcotics, intercostal, paravertebral or interpleural blocks, oral opioids, or simply a combination of the aforementioned interventions. In this study, we aim to compare the efficacy of thoracic epidural analgesia with systemic analgesia in patients with polytrauma. Methods This prospective study was conducted in the intensive care unit (ICU) of District Headquarters Hospital in Dera Ghazi Khan, Pakistan. Patients of age ≥18 years with skeletal trauma - rib fractures, limb fractures, and pelvic fractures - were included in the study. Group A patients were given epidural - bupivacaine and tramadol. Group B patients were given systemic analgesia with intravenous opioids. The severity of pain was assessed on the visual analogue scale (VAS) at time 0, 24 hours, and 48 hours. Data was entered and analysis was performed using Statistical Package for Social Sciences version 22.0. Results At 24 hours and 48 hours interval, group A showed a lower mean VAS score than group B ( p = 0.74; p = 0.03). Group A required lesser mean doses of additional short-acting analgesics than group B (4.87 ± 1.06 vs. 6.77 ± 1.44; p < 0.0001). In Group A, 94% were discharged and the mortality rate was 6%; in group B, 86% were discharged and the mortality rate was 14% ( p = 0.21). Conclusion Epidural analgesia provides better pain relief and requires fewer short-acting supplementing analgesics as compared to systemic analgesia in patients with multi-trauma.
Objective: Jerky involuntary intermittent abdominal wall movements are mentioned with numerous names including abdominal wall dyskinasia and belly dancer’s dyskinesia. Literature incorporates a sizeable amount of case reports. Patterson analyzed the largest series published in 2011. Although associated with central and peripheral nervous system disorders and published precipitating factors like anxiety, operations particularly abdominal, diarrhea, nutritional imbalances, pregnancy under the umbrella of idiopathic/psychogenic /functional belly’s dancer’s dyskinesia. Various investigations including blood count, ESR, CT, MRI, ECG plain radiography do not reflect any abnormality. Similarly a large number of modalities are utilized to manage the disorder from diazepam to phrenic nerve block; however no definite treatment has been mentioned. Magnesium calms down the excitability of central and peripheral nervous systems by inhibition of NMDA receptors and calcium influx mediated acetylcholine release. Magnesium deficiency results in excitability of the excitable tissues resulting in neuromuscular hyperactivity. We are reporting a patient who presented with abdominal wall dyskinasia, managed successfully with an infusion of magnesium sulphate which has never been described.
Background: General anesthesia is an essential component of anesthesia and endotracheal intubation is a basic step to secure the airway in patients undergoing any surgical procedure. Airway manipulation causes mucosal inflammation resulting in coughing, straining, bucking and subsequent distress to the patient. Aim: To find out whether preemptive use of nebulized lignocaine has some role in endotracheal tube tolerance during General anesthetic induction and emergence. Study design: Randomized control trial Methodology: The randomized controlled study was done on 68 patients scheduled for general surgical procedures.Patients were allocated intoGroup A and Group Bby closed envelope method with 34 patients in each group. In Group A lignocaine 2% (1.5-2mg/kg) with normalsaline 0.9% to prepare total of 5 ml solution, was used to nebulize the patients with face mask connected with O2 at 7L/min and in Group B5ml normal saline 0.9% was used to nebulize the patients for 15minutes. The endotracheal tube tolerance was noted at both intubation and extubation. Results: Endotracheal tube tolerancein Group A was markedly significant than in Group B both during intubation and extubation. In Group A, 32/34(94.12%) patients reflected tolerance to endotracheal tube both during intubation and extubation while in Group B only 06/34(17.65%) reflected tolerance to endotracheal tube both during intubation and extubation. Conclusion: Preemptive nebulized lignocaine suppresses the airway reflexes and significantly improves the endotracheal tube tolerance. Keywords: Endotracheal intubation, extubation, nebulization, lignocaine.
Background & objectives: Spinal anesthesia in children a useful alternative to general anesthesia, is not usually practiced in most of the hospitals of South Punjab. We aimed to evaluate the utilization of spinal anesthesia in children in South Punjab (Pakistan) and to discover the elements preventing its use in children. Methodology: A questionnaire was delivered to all 47 FCPS qualified anesthesiologists working in South Punjab vide e-mail and whatsapp messages to them. Out of 47 anesthesiologists, 38 (80.85%) responded. Questionnaire consisted of 3 components. All participants were asked to fill the first component regarding demographic data, but only those who did not administer spinal in children, needed to fill second and third components. In the second component, structured questions with scale 1 to 5 (strongly disagree to strongly agree). In the third component, the participant had open choice to write three most important factors (most important, second most and third most) prohibiting the practice of spinal anesthesia in children. Results: All of the 47 senior anesthesiologists working in South Punjab were included in this survey. The response rate was 80.85%. Demographic data showed 33/38 (87%) males and 05/38 (13%) females, mean age 44.34 ± 11.06 yrs, mean of total experience in anesthesia 17.03 ± 9.12 yrs and mean experience after postgraduation 8.01 ± 6.85 yrs. The number of respondents administering spinal anesthesia in children was just 3 (7.88%) and 35 (92%) never used spinal in children. Lack of expertise/training/guidance (4.69 ± 0.83) is the most common cause prohibiting the use of pediatric spinal anesthesia followed by risk of high/total spinal (4.14 ± 1.31), lack of cooperation of child (3.83 ± 1.34), risk of spinal cord injury (3.71 ± 1.51), difficulty in assessment of block (3.34 ± 1.64). Less common factors avoiding pediatric spinal include objection by family, objection by surgeon and lack of proper recommendations. The number of participants considering lack of expertise/training/guidance most important factors for avoiding spinal anesthesia in children was 9 (25.71%), followed by uncooperative children 8 (22.86%), risk of spinal cord damage 5 (14.28%), risk of high/total spinal 3 (8.57%) and objection by family 3 (8.57%). Other factors quoted were objection by the surgeon, risk of postdural puncture headache, risk of neurological complications, being short duration, not recommended and not acceptable by society. Conclusion: Pediatric spinal anesthesia is practiced by only three consultants (7.88%) in South Punjab out of a total of 47. There is a need to enhance the expertise level of the anesthesiologists during postgraduate training and to remove the fears / phobias attached with this particular practice. Key words: Pediatric; Anesthesia, Spinal; Barriers; South Punjab Citation: Durrani HD, Sadaf S, Naqvi SAA, Siddique A, Bajwa MH. Factors resulting in underutilization of pediatric spinal anesthesia in South Punjab (Pakistan). Anaesth. pain intensive care 2020;24(6):--- Received: 20 August 2020, Reviewed: 17 October 2020, Revised: 25 October 2020, Accepted: 6 October 2020
Objective: To compare the analgesic efficacy of tramadol wound infiltration with normal saline wound infiltration in patients undergoing Pyelolithotomy. Study Design: Randomized Controlled Trial. Setting: Department of Anesthesia, ICU and Pain Medicine, DG Khan Teaching Hospital, Dera Ghazi Khan. Period: July 2019 to September 2019. Material & Methods: Total 60 patients were included in this study. There were 30 patients in whom normal saline was used for wound infiltration and in other 30 patients tramadol was used for wound infiltration. Analgesic outcomes were noted in terms of Numerical Rating Scale (NRS) of pain in the recovery room, at 06 hours and 24 hours after surgery, mean time of first rescue analgesia and total dose of tramadol within 24 hours after surgery. Results: Mean pain score in the recovery room was 5.20±2.10 in saline group versus 2.60±1.13 in tramadol group (p<0.001). Mean post-operative pain score after 06 hours of surgery was 5.43±1.45 in saline group versus 2.30±1.05 in tramadol group (p<0.001). Pain score was 3.63±1.40 in saline group versus 1.67±0.80 in tramadol group after 24 hours of surgery (p<0.001). Mean time of first rescue analgesia was 6.16±2.47hours in tramadol group versus 0.97±1.46hours in saline group (p<0.001). Total dose of tramadol used for analgesia within 24 hours after surgery was 56.67±70.38mg in tramadol group versus 253.33±73.02mg in saline group (p<0.001). Conclusion: Wound infiltration with tramadol provides better analgesia as compared to normal saline in patients undergoing Pyelolithotomy.
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