Background: Anesthesia is essential in the treatment of postoperative pain. Epidural analgesia and trans versus abdominis plane (TAP) block are possible options for analgesia for abdominal surgery. Objective: The main objective of the study is to evaluate and compare the efficacy of epidural bupivacaine and trans versus abdominus plane (TAP) block to provide better post-operative pain relief in total abdominal hysterectomy. Study design and place of study: This study was a prospective randomized control trial conducted at Department of anesthesiology, Liaquat National Hospital, Karachi for the period July 2017- July, 2018. Methods: Total 101 patients were enrolled thorough pre anesthetic assessment before surgery and an informed and written consent was obtained. Patients were allocated in group A and B after taking all ASA monitoring, participants in group A had an epidural catheter passed while Group B patients were given transversus abdominis plane block intra-operatively. A Visual Analogue Scale (VAS) score was used to assess anxiety levels. Statistical test like the chi-square test was used, with a p-value of 0.05 being considered statistically significant Results: Total 101 participants enrolled, the average age was 45.48 ± 1.06 (Age Rang 30-60years). The mean age of patient in Epidural Group was 47.02± 7.62 as ccompared with TAP Block Group was 43.56± 13.35 with p-value 0.007. Majority of the patients has ASA II, 39(61.9%) and 24(38.1%) respectively with p-value 0.240. Pain score at 10 minutes in epidural and TAP Block was reported as 2.16±2.1o and 3.0±2.94 (mild pain) with p-value 0.000 while after 6 hours, the VAS pain score showed mild pain in epidural group as 1.96±1.67 but moderate to severe pain was observed in TAP block patients as 4.28±1.56 with insignificant p-value 0.162. Study findings will help care taker staff for Post-Operative Pain Relief after the surgery , the benefits of single shot TAP block could be of advantage in situations where epidural analgesia is contraindicated or not desired. Conclusion: The study concluded better pain relief in patients with epidural bupivacaine when compared with TAP block. Keywords: TAP Transversus Abdominus Plane ASA Physical Status Score VAS Visual Analogue Scale Epidural block, postoperative pain relief, Total Abdominal Hysterectomy, Transversus Abdominis Plane Block
Antibiotic lock solution (ALS) in the lumen of catheter is a mean to decrease the possibility of catheter related blood stream infection (CRBSI). We conducted this study using Gentamicin as ALS to observe the frequency of catheter related infections (CRI) including CRBSI and exit site infection in this hemodialysis patients being dialyzed through tunneled and temporary hemodialysis catheters. Methods This descriptive, cross sectional study was conducted at Dr. Ziauddin Hospital, North Campus between January 2017- December 2017. Symptomatic patients for CRBSI were included in this study. Blood culture from the catheter ports and periphery and exit site swab if pus visible were sent for culture sensitivity. Results Total 138 patients of either gender with age more than 18 years to less than 80 years were evaluated. 44.9% were male and mean age of patients was 58.79±14.05 years. 70.3% patients were diabetic for 15.61±4.61 years and 11.6% were using immunosuppressive drugs. The overall mean catheter duration was 22.27±14.39 days and mean hemodialysis duration was 25.32±44.31 weeks. Tunneled catheter was placed in 40.6% and 46.4% had femoral temporary catheters. Blood culture was done for 51 cases and 21.5% were positive. Tip culture was positive in 33.3% patients. In our study, 23.18% patients were found to have catheter related infections, out of which 61.5% were found with gentamicin resistance including colonization. Conclusion We report a high frequency of catheter related infections despite using ALS as prophylaxis, with predominant organisms being gram positives and a high incidence of gentamycin resistance.
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