Objective: To determine the effectiveness of dexmedetomidine on the spinal anaesthesia as an adjuvant to the hyperbaric levobupivacaine in patients undergoing cesarean section. Study Design: Comparative/Observational Place & Duration: The study was conducted at Anesthesiology/Obstetrics and Gynaecology departments of Mayo hospital, Lahore for duration of six months i.e from 1st November 2020 to 30th April 2021. Methods: This analysis included a total of 120 cases. After the informed consent the patients had received comprehensive demographics. Three equal classes of patients were divided into groups A, B and C. Group I had 40 patients and received 2.5 ml isobaric levobupivacane, group II with 40 patients and received 2.5 ml isobaric levobupivacaine and 5μg dexmedetomidine, and group III received 2.5 ml isobaric levobupivacaine and 25 μg fentanyl intrathecally. The outcomes of these groups were analysed in which sensory and motor blockage period were measured from the time the intrathecal drugs were administered. The full SPSS 26.0 version was used to analyze the results. Results: The mean age of the patients in group I was 27.44 ± 7.64 years with BMI 23.19±8.44, mean age in group II was 27.22 ±7.42 years with BMI 24.44 ± 6.16 and in group III mean age was 26.99 ±9.61 years with BMI 24.72 ±4.34. Duration of sensory and motor blockade was observed and resulted that it was earlier in group III as compared to group I and II. Prolonged duration of sensory and motor blockade was observed in group II as compared to groups I and III with significantly P value< 0.001. Conclusion: We concluded that for an adjuvant of 0.5 percent isobaric levobupivalacaine, Intrathecal dexmedetomidine induces both prolonged motor blockage and post operative analgesia than fentanyl. Key words: Levobupivacaine; Spinal anesthesia, Fentanyl, Intrathecal analgesia, Cesarean section; Dexmedetomidine.
Objective: The aim of this study is to compare the effects of low dose methylprednisolone and metoclopramide on nausea, vomiting and respiratory complications after adenotonsillectomy. Study Design: Retrospective study Place and Duration: The study was conducted in Divisional Headquarter Teaching Hospital, Mirpur AJK for duration of six months from December 2020 to May 2021. Methods: Total 150 patients of both genders underwent adenotonsillectomy presented in this study. Patients were aged between 3-15 years. Detailed demographics of enrolled cases age, sex and weight were recorded after taking informed written consent. Patients were equally divided into two groups. Group I had 75 patients and received 1 mg/kg IV methylpredinosolone and group II received 0.15 mg/kg metoclopramide among 75 patients. Post-operative effects on PONV were assessed and compared among both groups in terms of oral intake time, vomiting episodes, respiratory complications and side effects. Mean pain score was calculated by VAS. Complete data was analyzed by SPSS 23.0 version. Results: There were 40 (53.3%) females and 35 (46.7%) males in group I with mean age 9.43±1.44 years while in group II 42 (56%) were females and 33 (44%) were male patients with mean age 8.04±3.36 years. Mean weight of the patients in group I was 23.08±4.61 kg and in group II mean body weight was 22.11±6.84 kg. Mean operative time in group I was 27.41±8.53 min and in group II mean time was 28.17±6.34 min. Post-operative frequency of vomiting and nausea was lower in group I 14 (18.7%) and 16 (21.3%) as compared to group II 21 (28%) and 24 (34%). Low pain score was found in group I 1.71±6.11 as compared to group II 3.02±4.09. Time to oral intake was higher in group II 2.98±3.48 hours as compared to group I 1.09±7.51 hours. Rate of respiratory complications and side effects were significantly higher in group II. Conclusion: We concluded in this study that the use of methylpredinosolone was effective among patients those underwent for adenotonsillectomy in terms of post-operative frequency of PONV, pain, respiratory complications and side effects. Except this low dose of methylpredinosolone were effective in earlier tolerance of oral intake. Keywords: Adenotonsillectomy, Metoclopramide, Methylpredinosolone, Oral Intake
Background and Aim: Post-dural puncture headache is major complication of spinal anesthesia that occurs in 40% of cases. Invasive treatment like an epidural blood patch might be required for post-dural puncture headache. The Dexamethasone effect on Post-Dural Puncture Headache following spinal anesthesia is not addressed and well understood. The aim of the present study was to assess the role of Dexamethasone in post-dural puncture headaches. Materials and Methods: This cross-sectional study was carried out on 456 patients who underwent spinal anesthesia from 16th April 2021 to 15th October 2021 at the department of Anesthesiology of Pakistan Ordnance Factories (POF)Hospital,WahCantt, Mayo Hospital, Lahore andMohi-ud-Din Teaching Hospital, Mirpur AJK. All the patients who underwent spinal anesthesia were enrolled whereas patients with previous headache disorder and contraindicated for steroids were excluded. Patients were allocated to two groups; Group A (Placebo) and Group B (Dexamethasone). Placebo group patients were injected with normal saline (2 mL) and other group patients with dexamethasone prophylactic epidural injection (2 mL, 8 mg). The incidence and severity of post-dural puncture headache and backache at the puncture site were evaluated on the 1st, 3rd, and 7th postoperative days. SPSS version 24 was used for data descriptive analysis. Results: A total of 456 patients underwent spinal anesthesia in which 228 patients over age of 20 years were assigned to each group. The prevalence of post-dural puncture headache was found lower in dexamethasone group patients 14 (6.2%) compared to normal saline 26 (11.6%) on the post-operative first day (p<0.05). However, on days 3 and 7, the difference disappeared. The overall prevalence of post-dural puncture headache was 21 (9.4%) in the dexamethasone group and 11 (4.7%) in the placebo group, which is statistically insignificant (p-value=0.132). There was no statistical significance in terms of headache severity (2.7% in the study group versus 7% controls group; p-value =0.128). The incidence of symptoms like vomiting or nausea occurred in a lower number of dexamethasone group patients compared to placebo. The prevalence of backache between the two groups was found insignificant. Conclusion: Our study found that the prevalence of post-dural puncture headache was lower in dexamethasone group patients but improved with increasing post-operative days and extended to the placebo group. Our findings contradict the earlier studies in regard to dexamethasone's effectiveness in post-dural puncture headache treatment. Based on our findings, dexamethasone cannot be recommended for post-dural puncture headaches. Keywords: Post-Dural puncture headache; Dexamethasone; Spinal Anesthesia
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