Background: Ultrasound-guided transversus abdominis plane (TAP) block has been used for analgesia in lower abdominal surgery. In the literature, there are inconsistent reports regarding the efficacy of TAP block in different open abdominal procedures. Therefore, we conducted this prospective randomised doubleblind study to evaluate the pattern of perioperative analgesia and to validate the efficacy of TAP block in patients undergoing lower abdominal surgery.
IntroductionNeuropathic pain (NP) can cause substantial suffering and, therefore, it must be diagnosed and treated promptly. Diagnosis of NP can be difficult and if made by an expert pain physician is considered the gold standard, however where expert help may not be easily available, screening tools for NP can be used. The painDETECT questionnaire (PD-Q) is a simple screening tool and has been widely used in several languages. We developed an Arabic version of PD-Q and tested its validity and reliability.MethodsThe original PD-Q was translated into the Arabic language by a team of experts. The translated version of the PD-Q was administered to the study population, which included patients having moderate to severe pain for at least three months. Reliability of the Arabic version was evaluated by an intra-class-correlation coefficient (ICC) between pre- and post-measures and Cronbach’s α values. Validity was measured by receiver operating characteristic (ROC) curve. Expert pain physician diagnosis was considered as the gold standard for comparing the diagnostic accuracy.ResultsA total of 375 patients were included in the study, of which 153 (40.8%) patients were diagnosed with NP and 222 [59.2%] patients had nociceptive pain. The ICC between pre- and post-PD-Q scale total scores for the overall sample, NP group, and NocP group was 0.970 (95% CI, 0.964–0.976), 0.963 (95% CI, 0.949–0.973), and 0.962 (95% CI, 0.951–0.971), respectively. The Cronbach’s α values for the post-assessment measures in the overall sample, NP group, and nociceptive pain group, were 0.764, 0.684, and 0.746, respectively. The area under the ROC curve was 0.775 (95% CI, 0.725–0.825) for the PD-Q total score.ConclusionThe Arabic version of the PD-Q showed good reliability and validity in the detection of NP component in patients with chronic pain.
Diagnosis of neuropathic pain (NP) can be challenging. The ID Pain (ID-P) questionnaire, a screening tool for NP, has been used widely both in the original version and translated forms. The aim of this study was to develop an Arabic version of ID-P and assess its validity and reliability in detecting neuropathic pain. The original ID-P was translated in Arabic language and administered to the study population. Reliability of the Arabic version was evaluated by percentage observed agreement, and Cohen’s kappa; and validity by sensitivity, specificity, correctly classified, and receiver operating characteristic (ROC) curve. Physician diagnosis was considered as the gold standard for comparing the diagnostic accuracy. The study included 375 adult patients (153 [40.8%] with NP; 222 [59.2%] with nociceptive pain). Overall observed percentage agreement and Cohen’s kappa were >90% and >0.80, respectively. Median (range) score of ID-P scale was 3 (2–4) and 1 (0–2) in the NP group and NocP group, respectively (p<0.001). Area under the ROC curve was 0.808 (95% CI, 0.764–0.851). For the cut-off value of ≥2, sensitivity was 84.3%, specificity was 66.7%, and correct classification was 73.9%. Thus, the Arabic version of ID-P showed moderate reliability and validity as a pain assessment tool. This article presents the psychometric properties of the Arabic version of ID Pain questionnaire. This Arabic version may serve as a simple yet important screening tool, and help in appropriate management of neuropathic pain, specifically in primary care centers in the Kingdom of Saudi Arabia.
Objective: The consumption of motorbike is increasing in Asia. The aim of this study was to analyze the head injuries due to motorcycle accidents attended in the District Headquarter (DHQ), Dera Ismail Khan. Material and Methods: All the age groups from both genders were part of our study. All the patients show reduced GCS with some sign of having abnormalities on Computed tomography (CT) brain were included in our eligibility criteria. Pedestrians, those died before hospital arrival, complain about any other type of injury other than a head injury, and not have proper admission in the hospital was excluded from the study.Results: 478 patients were included in the current study. More than 44.14% of accidents were reported in patients aged 20 – 29 years. 441 (92.25%) were men, and 381 (79.7%) were driving themselves. Among 478 only 71 (14.85%) were wearing a helmet. Almost 47.48% of the accidents occurred on the weekend. 274 (57.32%) patients reached the hospital within 5 hours after the accident. 218 (45.6%) patients had a head injury. Brain edema was the most common CT abnormality 214 (44.8%).Conclusion: Mainly, the males were affected by a motorcycle accident and face head injury in the third decade of their life. The CT scan indicates brain edema as the most common findings. 45.6% of patients have a severe head injury and a mortality rate of 13.4% was reported.
The practice of percutaneous dilatational tracheostomy (PDT) has gained popularity and acceptance due to the ease in acquiring its skill and low probability of complications. Nevertheless, PDT is associated with a few complications, some really life-threatening. We present a case of an abnormally located common carotid artery encountered during PDT in our intensive care unit. The procedure was electively posted, in an old patient chronically ventilated after a revived cardiac arrest. While identifying the landmarks on palpation pulsation was felt similar to arterial pulsation. This was confirmed using bedside portable ultrasonography and found to be the right common carotid artery forming a loop anterior to the trachea at the level of the third and fourth tracheal rings. The patient had a past history of thyroidectomy and this was suspected to be the primary reason for the altered course of the right common carotid artery.
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