Background: There is a risk associated with spinal anaesthesia failure after immediate deliverance of epidural anaesthesia. Objective: To assess the risk of spinal anaesthesia failure followed by failed epidural block in caesarean deliveries. Study Design: Retrospective study Place and Duration of Study: Department of Obstetrics & Gynaecology, Khairpur Medical College Khairpur Mir’s from 1st July 2020 to 30th June 2021. Methodology: One hundred and seventy labour cases who have been given epidural anaesthesia and were prepared for caesarean section through spinal anaesthesia were included. The demographic and clinical information of each pregnant female was documented. Proper epidural dosage was maintained during labour. Results: The mean age of the patients was 26.5±5.2 years. There was a significant increase in body mass index among epidural converted spinal aesthesia patients. The higher incidence of non-reassuring foetal heart tracing and malpresentation in failure cases were found. Conclusion: There is a 11.17% risk of spinal anaesthetics failure for attaining block height when administered within 30 min of epidural dose. Keywords: Epidural, Spinal anaesthesia, Anaesthesia, Caesarean
Objective: To assess the effect of pregabalin in reducing the postoperative requirement of analgesics of patient undergoing knee arthroscopic anterior cruciate ligament repair surgery. Study Design: Prospective randomized control trial. Place and Duration of Study: Department of Anesthesia, Ghurki Trust Teaching Hospital Lahore from 1st June 2021 to 31st December 2021. Methodology: Eighty patients were randomly divided into two groups; group A and group B, each group comprised 40. Group A receive placebo and group B receive pregabalin 150mg once a day for two days after surgery. Pain assessment done with the help of Numeric Rating Scale and rescue analgesia was recorded. Results: The mean age was 31±10.2 years of group A and 33±10.3 year of Group B. There were more males within both groups in comparison to females with a percentage of 77.5% and 85% respectively. The reduction was seen within Group B in comparison of Group A in terms of ASA class, VNRS, and maximum sensory block. Cumulative volume of PCA in ml was also less in group B than group A with a significant difference within 0-6 hours. Conclusions: The use of pregabalin 150mg after surgery for two days significantly reduces the analgesic consumption Keywords: Pregabalin, Postoperative analgesic, Numeric rating scale
Summary: The development of clinical ultrasound was perhaps the greatest revolution in the medical profession during the last half century. The rapid evolution allowed novel uses od US in almost every field of medical practice. Its best use, probably has been in the hands of the anesthetists, who employ it the operating room, in the pain clinic as well as in the emergency room and in the intensive care units. Apicare Journal has strived to introduce this novel modality in this part of the world by editorials and research papers. This invited editorial has been written by one of the best US and POCUS teams in Pakistan, at Ghurki Trust Teaching Hospital, Lahore, Pakistan. It offers a brief introduction to some of the countless options in which it can be used. The authors stress on the availability of US facility and the training to all clinicians. Key words: POCUS (Point of Care Ultrasound); FAST Scan; eFAST Scan; Pain; Pain Management; Anesthetist; Stethoscope; Gastroparesis; Airway Citation: Ayub L, Dar SR, Chaudhary WA. POCUS: the anesthetist’s emerging stethoscope. Anaesth. pain intensive care 2022;26(6):736−738; DOI: 10.35975/apic.v26i6.2065Received: October 26, 2022; Revised: October 29, 2022; Accepted: October 29, 2022
Aim: To determine the effectiveness among pendant position and traditional sitting position in term of successful spinal puncture in patients underwent caesarean deliveries. Study Design: Randomized control trial Place and Duration of Study: Department of Anaesthesia, Ghurki Trust Teaching Hospital, Lahore from 1st April 2020 to 31st March 2021. Methodology: One hundred and eighty patients were included. Patient’s detailed demographics were recorded after taking written consent. Patients were aged between 20-50 years. Patients were equally divided into two groups, group I had 90 patients underwent pendant position and group II had 90 patients and underwent for traditional sitting. Randomly one of two positions was performed with the L3-L4 interface in spinal puncture. Time for successful spinal puncture, number of needle to bone contacts and total number of attempts were calculated. Results: Mean age of the patients in group I was 27.6±17.04 years with mean BMI 24.25±2.63 kg/m2 and in group II, mean age was 29.23±14.24 years with mean BMI 26.55±6.36 kg/m2. Mean height of patients in group I was 2.6524±1.0054 meter and in group II was 2.6516±1.0042 meter. Weight of the patients in group I 63.48±22.13 kg and in group II was 65.46±17.19 kg. Success rate after first attempt in group I was 80 (94.44%) and group II was 72 (80%). For spinal needle insertion, fewer mean times was observed in group I 19.55±11.221 sec as compared to group II 28.14±18.226 sec. Number of needle to bone contacts was higher 66.7% in group I and in group II 40%. Number of attempt was less in group I as compared to group II. Conclusion: The pendant position in the pregnant women who had a caesarean sector was much better than the standard position in order to provide the 1st attempt of spinal puncture. Keywords: Caesarean, Spinal anaesthesia, Traditional sitting, Pendant position
Aims: This study has been conducted to evaluate anti arthritic effects of compesterol, a phytosterol, which has been used to treat inflammatory disorders. Methodology: A study was conducted using the CFA-induced arthritic rat model to investigate campesterol's potential antiarthritic and anti-inflammatory effects. The study used thirty female rats, randomly divided into five groups, each containing six rats. CFA was injected on Day 0 to induce arthritis in the rats. Treatment with campesterol began on Day 8 and continued until Day 28. The arthritic score and paw edema volume were measured on Days 7, 14, 21, and 28. After the rats were sacrificed, blood samples were collected for further analysis. Different pro inflammatory mediators, histopathological parameters, X-Ray interpretation, biochemical parameters, q-PCR, and ELISA were also assessed . These assessments were likely used to investigate the potential mechanisms underlying the observed effects of campesterol on arthritis and inflammation in the rats. Results: Based on the results reported, treatment with campesterol appeared to have a positive effect on the arthritic rats. Specifically, the treatment inhibited the development of arthritis and decreased paw edema. The histopathological parameters evaluated were also significantly reduced, suggesting that the treatment may have positively affected the underlying pathology of arthritis. The qPCR analysis showed that treatment with campesterol significantly reduced pro-inflammatory cytokines TNF-a, NF- κB, IL-6, COX II, and IL-1 levels and potentiation of anti-inflammatory cytokine IL-4 levels. ELISA showed decreased levels of PGE2, a marker of inflammation, in all treated groups. The blood and biochemical parameters in the treated groups were nearly normalized, with restored levels of Hb and RBCs and reduced levels of WBCs. Platelets were also found to be normalized in treated groups. Significant differences were observed in the total bilirubin, creatinine, urea, ALT, AST, ALP, and rheumatoid factor between the treated and arthritic control groups, indicating that the treatment may have had a positive effect on these parameters as well. The results suggest that campesterol may have the potential as an antiarthritic and anti-inflammatory agent. Further studies could help elucidate its mechanisms of action and potential clinical applications. Conclusion: Paw edema reduced significantly compesterol, arthritic score as compared to diseased control group. Histopathologic, Haematological and biochemical parameters i.e. qPCR results showed supression of pro inflammmatory biomarkers such as TNF- α, NF-KB, IL-6, COX II and IL-1 and augmented levels of IL4 as compared to diseased control group. PGE 2 levels were found significantly reduced after treatment. This study validates immunomodulatory role of compesterol in rheumatoid arthritis. The compound had effects comparable with piroxicam.
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