Introduction Posttonsillectomy pain results in significant morbidity to the patients. There is a disagreement in the literature regarding the use of local anesthetics during tonsillectomy. The aim of this placebo-controlled, double-blind study is to evaluate the effect of peritonsillar administration of local anesthetics. Objective To evaluate the role of intraoperative use of analgesics in tonsillar fossa and postoperative evaluation with visual analogue scale (VAS) scores in achieving pain relief after tonsillectomy procedure Methods In this study, 180 patients were randomized to 1 of the 6 groups: bupivacaine infiltration, lidocaine infiltration, normal saline infiltration, bupivacaine packing, lidocaine packing, and normal saline packing. Pain caused by speaking, swallowing, and on rest was assessed using VAS at 4, 8, 12, 16 hours, and at discharge. Results Significant analgesia was obtained in patients who received bupivacaine infiltration and packing compared with placebo ( p < 0.05). The majority of the study subjects had no postoperative complications, and patients receiving bupivacaine infiltration required less additional analgesics in the first 24 hours after surgery. Conclusion We advocate the use of bupivacaine infiltration or packing immediately following the procedure to achieve adequate postoperative analgesia.
Background:One of the prevailing otologic infections in our country is chronic suppurative otitis media, especially the tubotympanic type for which various treatment protocols are followed. Usually, oral and topical antibiotics (mainly quinolones) are given alone or in combination. There is a lack of consensus as to whether topical drops alone are effective or a combined oral and systemic therapy should be prescribed. In our study, we have attempted to observe the efficacy of empirical therapy with combined ciprofloxacin versus topical drops only in patients with tubotympanic chronic suppurative otitis media for control of infection.Methodology:A total of 100 patients visiting the outpatient ENT department at our tertiary care hospital with clinically diagnosed chronic suppurative otitis media (tubotympanic type) were enrolled in our study. The study was reviewed and accepted by the ethical review committee. A detailed proforma was filled for all patients. All patients after aural toilet were subjected randomly to one of the 2 treatment methods, ie, topical ciprofloxacin ear drops plus an oral placebo or combined oral and topical ciprofloxacin. These patients were reviewed after 1 week of treatment.Results:It was observed that 48 of 50 (96%) patients responded to treatment in the group receiving topical ciprofloxacin, whereas 49 of 50 (98%) patients responded in the group receiving combined therapy. This difference was not significant. Moreover, age, sex, and duration of discharge did not have any effect on treatment. There were minimal side effects in both groups, which were also not significant and disappeared after discontinuation of treatment.Conclusions:The results of this study show that topical ciprofloxacin drops were as effective as combined oral and topical ciprofloxacin and that the addition of oral drug did not have any beneficial effect and added only to the cost of treatment.
Background: The issues pertaining to postgraduate medical education have been debated for long but there has been little contribution to this literature from developing countries. Therefore, a need to make an accurate assessment regarding current status of postgraduate training in Pakistan was felt and feedback from residents is the cornerstone of such an assessment. The objective of our study was to document perceptions of FCPS trainees of medical and surgical disciplines in private and public tertiary care hospitals of Karachi, Pakistan.Material and Methods: This was a cross sectional survey of the medical and surgical FCPS trainees in three hospitals (1 public and 2 private) of Karachi Pakistan, conducted over a period of two months (1st November 2018 to 31st December 2018). A total of 325 participants selected by convenient sampling technique were included in the study. Data was collected through structured self-developed questionnaire and analyzed by SPSS version 16.0.Results: The percentage of postgraduate trainees in private hospitals working for more than 80hours/week is higher than those working in public sector hospitals (59.4% versus 42.4%). Topic presentation and Academic meetings (Conferences, Workshops and CMEs) were the most preferred teaching strategies in Postgraduate training (77.4% and 77.5%). About 62.7% of the residents believed that their program was in line with CPSP guidelines. Public sector hospitals were better in terms of medical benefits giving partial cover (62.8%) than private sector (P-value <0.001). Majority of trainees at private sector hospitals seemed satisfied with their working environment than at public hospital (77.5% versus 12.5%) (P-value <0.001). Trainees perceived that the security arrangements at both public and private hospitals were not adequate, but in case of emergency private hospitals seemed to have better security response as compared to public hospitals (89% versus 23%) with a significant difference of <0.001.Conclusions: Perception of most of the postgraduate trainees is that they are being adequately trained for the challenges of an independent physician or surgeon.Key words: Postgraduate training programs, Medical education, Trainees perception
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