The need for early ambulation for caring of the neonate by mothers makes postoperative pain management after cesarean delivery unique. Favorable results have been observed with buprenorphine, clonidine and bupivacaine as epidural analgesics. This prospective, randomised triple blind control study was carried out among 112 lower segment caesarean segment (LSCS) patients, divided into three groups, to assess the analgesic efficacy and side effects of epidural analgesia, with an intermittent top up of (i) bupivacaine (0.125%) and buprenorphine (0.075 mg) (ii) bupivacaine (0.125%) and clonidine (37.5 microgram) and (iii) bupivacaine (0.125%) alone, in LSCS cases. The demographic characteristics (age, weight and height) of the three groups were comparable and the differences were not statistically significant. The mean duration of the analgesia was significantly longer in the group one patients receiving buprenorphine plus bupivacaine (690 ± 35 minutes) and it was lowest in group three patients receiving bupivacaine (170 ± 31 minutes) alone. The mean highest pain score (VAS scale) was significantly lower (3.4 ± 0.6) in group one patients and it was highest in group three (6.7 ± 0.8) patients. Requirement of continuation of epidural analgesia after 15 hours of operation and requirement of diclonfenac injections as well as incidence of itching and pruritus was significantly lower in group one patients. Incidence of nausea and vomiting was the lowest in group one patients. Incidence of respiratory depression, sedation and hypotension were nil in all three group of patients. Epidural buprenorphine combined with bupivacaine produced significantly longer duration and better quality of analgesia than bupivacaine combined with clonidine or bupivacaine alone, and it was safe in LSCS patients, for post-operative analgesia.
Introduction: Transient intraocular pressure rise is a commonly observed phenomenon following Nd:YAG capsulotomy. However, IOP change is considered to be dependent on multiple factors. Study aimed to assess factors determining the IOP change following Nd:YAG capsulotomy. Material and Methods: A total of 150 adult patients, scheduled to undergo Nd:YAG laser capsulotomy for management of posterior chamber opacification (PCO) were enrolled. Age, gender, time since cataract surgery, PCO grade, IOP, topical hypotensive use was noted in all the cases. Amount of energy used in Nd:YAG procedure was recorded. Postoperative IOP change was noted immediately, 1 hr and 3 hr postoperative intervals. Rise >5 mm was considered clinically significant. Independent samples 't'-test, Chi-square test and binary logistic regression were used. Data analysis was performed using SPSS 15.0 software. Results: Mean age of patients was 60±11.3 years. Majority were females (59.3%). Majority of patients had Grade I and II of PCO (64%), 5-10 years duration since cataract surgery (79.3%) and topical hypotensive use was done(58%). Preoperative mean IOP was 15.99±2.72 mmHg. Energy used was 55.7±52.7 mJ. A total of 19 (12.7%) patients had IOP rise >5 mm. On univariate analysis, Grade III or above PCO, higher level of total energy use and low hypotensive use were found to be significantly associated with IOP rise. On multivariate assessment, low hypotensive use and high energy use were found to be significantly associated with clinically significant IOP rise (p<0.05). Conclusions: Low energy and prophylactic topical hypotensives were protective against IOP rise.
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