Comparison between subcutaneous ketamine with intramuscular pethidine versus intramuscular pethidine for post-operative analgesia after cesarean section

Abstract Background Cesarean section is one of the most common operations. Women undergoing cesarean delivery should achieve adequate postoperative pain relief because of different factors related to the operation complications as well as maternal and neonatal well-being. Immobility due to inadequate pain control could result in thrombo-embolic events, inappropriate neonatal care and delay in discharge which consequently increase the cost of this common procedure both for patients and health care system. Objective to investigate the efficacy of adding subcutaneous ketamine for postoperative analgesia in cesarean section and comparing it to using intramuscular pethidine only regarding opioid requirements and pain level. Patients and Methods The present study was carried out on two groups of women (each group consists of 25) after undergoing cesarean section under spinal anesthesia in Ain Shams University Hospitals and Helwan University Hospitals. Group A patients were given three doses of subcutaneous ketamine (0.9 mg/kg) at post-operative care unit (PACU), 12 and 24 hours after the operation with intramuscular pethidine (50mg) given when patients’ numerical pain score exceeded 5. Group B patients were given three doses of placebo at same intervals as group A and were given intramuscular pethidine (50mg) when NRS score exceeded 5. Results There was significant decrease in pain scores between two groups PACU, 12 and 24 hours postoperative with no significant change in the rest of the study. There was highly significant increase in the time to first pethidine demand in group A than B. There was highly significant decrease in total dose of pethidine given (in group A than in B. Conclusion Subcutaneous ketamine with a dose of (0.9mg/kg) can be used in reducing pain in postoperative period after CS with minimal side effects. The addition of SC ketamine to the pethidine appear to cause more pain control and decrease the total dose of pethidine given in post-operative period.

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Comparison of Tramadol Versus Tramadol and Paracetamol in Postop Pain Management after C-Section

10.53350/pjmhs211551035 ◽

2021 ◽

Vol 15 (5) ◽

pp. 1035-1037

Author(s):

Usman Salamat ◽

M.Baqir Ali Khan ◽

Liaqat Ali ◽

Tahir Nazeer ◽

Amna Tahir ◽

...

Keyword(s):

Body Weight ◽

Pain Management ◽

Cesarean Section ◽

Pain Control ◽

Elective Cesarean Section ◽

Post Surgery ◽

Postop Pain ◽

Elective Cesarean ◽

Group A ◽

Group B

Background: Multimodal technique of pain control is better than unimodal technique in perioperative time. Both tramadol and paracetamol are commonly used for pain control. Aim: To compare the tramadol alone versus tramadol with paracetamol in pain management after C- section. Method: 150 patients with ASA class P1&P2 undergoing elective cesarean section under general anesthesia were included in this study and were divided into group A & B by random number table. In both group tramadol 1mg/kg body weight intravenous was given after delivery of baby and in group B intravenous paracetamol 15 mg/kg body weight was given additionally and same doses were given in postop after 8 hours for 24 hs of post-surgery. Result: Mean age in group A was 31.04±5.35 years and in group B it was 29.64±5.92. Mean pain score in group A was 1.19±0.81 and in group B it was 0.60±0.75. The degree of pain was low in group B and patients were more comfortable as compared to group A patients. Conclusion: Tramadol plus paracetamol has better pain control as compared to tramadol alone. Keywords: Tramadol, Paracetamol, Cesarean Section, VAS.

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Comparison of the effects of Dexamethasone and Ondansetron on the Reduction of Postoperative Nausea and Vomiting following Cesarean Section under Spinal Anesthesia

Current Clinical Pharmacology ◽

10.2174/1574884715666200302122800 ◽

2020 ◽

Vol 15 ◽

Author(s):

Arash karimi ◽

Jahanbakhsh Nejadi ◽

Mahnaz Shamseh ◽

Nooshin Ronasi ◽

Mehdi Birjandi

Keyword(s):

Cesarean Section ◽

Spinal Anesthesia ◽

Postoperative Nausea ◽

Demographic Data ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Elective Cesarean Section ◽

Double Blind ◽

Group A ◽

Group B

Background: Postoperative nausea and vomiting (PONV) is a common complication associated with the use of anesthesia. Several antiemetics are used to reduce the incidence and severity of PONV. The aim of this study is to investigate the role of dexamethasone and ondansetron to treat PONV in patients undergoing cesarean section (c-section) under spinal anesthesia. Methods: This double-blind clinical trial study was performed on patients who were referred to the operating room of Haji Karim Asali Hospital of Khorramabad for elective cesarean section in 2016-17. Upon meeting the inclusion criteria, patients were allotted into two groups (n=60). Group A received 8mg of dexamethasone and group B received 4mg of ondansetron after spinal anesthesia. The Visual Analog Scale (VAS) questionnaire and Depression-Anxiety-Stress Scale (DASS) questionnaire was used for the analysis. Patients with mild to moderate stress, anxiety, and depression were included in the study. Data were analyzed using SPSS 16 software. Results: There was no difference in the demographic data of the two groups. The mean severity of nausea in group A was significantly higher than in group B. The frequency of vomiting in group A was 20 times higher than group B, which was found to be statistically significant, p = 0.018. Concerning the type of delivery with the frequency of nausea, the results showed that the frequency of nausea in group A was 3.24 times higher than group B, however, this difference was not statistically significant, p = 0.106. Conclusion: Based on the results of this study, ondansetron had a significant effect on the alleviation of postoperative nausea and vomiting, as compared to dexamethasone in c-section surgical candidates.

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Effects of Diaphragmatic Breathing and Systematic Relaxation on Depression, Anxiety, Stress, and Glycemic Control in Type 2 Diabetes Mellitus

International Journal of Yoga Therapy ◽

10.17761/2021-d-19-00061 ◽

2021 ◽

Author(s):

Abhishek Yadav ◽

Rajeev Mohan Kaushik ◽

Reshma Kaushik

Keyword(s):

Glycemic Control ◽

Well Being ◽

Depression And Anxiety ◽

Diaphragmatic Breathing ◽

Group A ◽

Student’S T ◽

Group B ◽

Mental Well Being ◽

Student’S T Test

Abstract This prospective study assessed the effects of diaphragmatic breathing and systematic relaxation on depression, anxiety, and stress levels, as well as glycemic control, in patients with type 2 diabetes mellitus (T2DM). One hundred patients with T2DM were randomly assigned to two equal groups: Group A patients received conventional treatment for T2DM, and Group B patients received conventional treatment for T2DM plus training in diaphragmatic breathing and systematic relaxation and home practice of these stress-management techniques for 6 months. Stress, depression, and anxiety levels, blood sugar, and glycated hemoglobin (HbA1c) were recorded at baseline and after 6 months of treatment in all patients. Baseline characteristics were compared using the chi-square test and student’s t test. Changes in mental well-being and glycemic status were assessed for their significance in each group using student’s t test and compared between two groups using one-way analysis of covariance (ANCOVA). Baseline levels of the respective change outcome and duration of diabetes were used as covariates in the ANCOVA. A significant decrease was seen in depression, anxiety, and stress scores in Group B, but in Group A only the stress score decreased after 6 months. A significant decline occurred in blood sugar (fasting, 2-hour postprandial, and random) and HbA1c in both groups after 6 months. There was a larger decrease in depression and anxiety scores and HbA1c in Group B than in Group A. The decrease in HbA1c was significantly correlated with the decrease in anxiety and stress scores in both groups and with the depression score in Group A. Thus, the addition of diaphragmatic breathing and systematic relaxation to conventional T2DM treatment appears to have led to improvement in mental well-being and glycemic control in patients with T2DM.

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Aesthetic outcome and patient’s quality of life in breast cancer patients undergoing mastectomy with or without immediate reconstruction.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e12587 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e12587-e12587

Author(s):

Sidra Afzal ◽

Asad Parvaiz ◽

Nida Javed

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Well Being ◽

Mean Difference ◽

Breast Cancer Patients ◽

Immediate Reconstruction ◽

Patient’S Satisfaction ◽

Group A ◽

The Mean ◽

Group B

e12587 Background: : Although post mastectomy Immediate breast reconstruction has shown to improve physical and psychosocial well-being of breast cancer patients, this is not a usual procedure in Pakistan due to limited resources and lack of awareness. The aim of our study is to evaluate patient’s satisfaction/ aesthetic outcomes between the patients undergoing mastectomy alone (Group A) and the ones undergoing mastectomy followed by immediate reconstruction (Group B). Methods: This is a prospective study conducted at Shaukat Khanum Hospital Pakistan comparing aesthetic outcome, patient’s satisfaction and Quality of life between two groups using Breast Q module. All patients undergoing mastectomy with and without reconstruction between April 2017 to July 2019 are included. Sample size of 84 was calculated (42 in each group). Results: The mean Q score of satisfaction with the breast in group B is 82.64 and in group A is 35.82 (P = 0.001). The mean Q score of Psychosocial well-being in group B is 89 vs 44.95 in group A (P = 0.001). The mean Q score of Physical well-being in group B is 98.23 vs 90.41 in group A (P = 0.002). The mean Q score of sexual well-being in group B is 81.93 vs 43 in Group A (P = 0.001). [Mean difference in score of 5-10 - little change, 10-20 - moderate change, > 20 - significant change].The mean difference between two groups in satisfaction with breast , psychosocial well-being and sexual well-being is more than 20 with a statistically significant p-value, while in physical well-being the mean difference is 7.8 which falls in little change group. Conclusions: Our study shows that reconstruction helps breast cancer patients in providing comprehensive care in a manner that they achieve a higher satisfaction with their appearance, psychological and sexual well-being without compromising oncological safety and this should be practiced more in our country. Also patients education about these procedures should be raised to help them fighting against this disease

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Gamification as an entrepreneur well-being intervention: A study protocol for a single-blinded randomised controlled trial

10.21203/rs.3.pex-1323/v1 ◽

2021 ◽

Author(s):

Waqar M. Naqvi

Keyword(s):

Controlled Trial ◽

Life Quality ◽

Well Being ◽

Likert Scale ◽

Control Group ◽

Group A ◽

Measuring Scale ◽

Group B ◽

Randomised Controlled

Abstract Entrepreneurs usually work for long hours resulting in exhaustion, stress, and burnout. The prevalent symptoms of burnout are reduced levels of physical and mental energy, reduced job efficiency and diminished productivity. Therefore, it is important to improve the health of entrepreneurs. Gamification has a positive relationship with improvements in health and well-being as it influences positive experiences and satisfaction. This trial aims to study how 30-minutes of virtual reality game use via Kinect Azure and Oculus platforms 3-times per week, for 4 weeks, relates to differences in entrepreneur stress, burnout, subjective life quality, and downstream firm performance. We will recruit entrepreneurs over the age of 18 for the gamification analysis. Analysis of previous power using G*Power will determine the sample size. We will divide the participants into 3 groups, wherein Group A will undergo gamification on the Kinect platform, Group B will undergo the Oculus Quest intervention, and Group C will be the control group. We will conduct the study at two sites, one at the HuMen research. The outcome measures include a five-point Likert scale for measuring entrepreneurial stress, burnout-measuring scale (BMS) for burnout, five-point Likert scale for performance and SF-12 for Quality of life. Since current strains pave ways to future accomplishment, entrepreneurs' eudemonic well-being might particularly relate to forward-looking challenge stressors and burnouts. The results will provide an insight into how gamification could help entrepreneurs to deal with work stress and maintain high well-being.

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Antibiotic usage rates in bacterial versus nonbacterial diseases: a new way to monitor hospital-acquired infections in children: a retrospective case analysis

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20204540 ◽

2020 ◽

Vol 7 (11) ◽

pp. 2176

Author(s):

Jayendra R. Gohil ◽

Chintu C. Chaudary ◽

Sheena D. Sivanandan

Keyword(s):

Antibiotic Usage ◽

Retrospective Case ◽

Hospital Acquired Infections ◽

Group A ◽

Added Benefit ◽

Reduction Of Mortality ◽

Group B ◽

The Cost ◽

Hospital Acquired ◽

Selection Of

Background: While treating children, the selection of antibiotics, when indicated, should be from the point of its effectiveness, safety, suitability, and cost. However, this flow of action does not take place in all cases. Aim of the study was to assess the antibiotic usage in admitted children and mortality.Methods: The case records between January to July 2012 in children wards was evaluated for the use of antibiotics. Patients were grouped into; group A- ‘must use' antibiotic in all, and group B- where antibiotics are not indicated.Results: There were 1852 admissions, including 719 Thalassemia cases. Antibiotic usage was 63% in 1133 cases after excluding thalassemia. Out of 1133 cases, 423 were in group A and 710 cases were in group B. In group B the antibiotic usage was 41%. The mortality was 6.6% and 4.8% in group A and B. Inside group B, mortality was 5.9% versus 4.0% in those administered versus not administered, antibiotics.Conclusions: There was no increase in mortality in patients in whom antibiotics were not prescribed, and no added benefit of prescribing antibiotics was observed in nonbacterial group B disease patients. The mortality was similar in both the groups. In nonbacterial group B, the antibiotics did not offer any advantage in the reduction of mortality, but increased the cost of the treatment, and possibly the chance of development of drug resistance and adverse events. When analysing the hospital antibiotic usage, only the nonbacterial diseases should be considered to get a true picture of the inappropriate prescription of antibiotics.

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Comparative study of endoscopic tympanoplasty and conventional tympanoplasty

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20204179 ◽

2020 ◽

Vol 6 (10) ◽

pp. 1804

Author(s):

Priyanka Aggarwal ◽

Barjinder Singh Sohal ◽

J. P. Goyal

Keyword(s):

Success Rate ◽

Cost Effective ◽

Patient Comfort ◽

Hearing Improvement ◽

Post Operation ◽

Group A ◽

Group B ◽

The Cost ◽

Results Of Surgery ◽

Endoscopic Tympanoplasty

Background: To compare the results of endoscopic tympanoplasty with that of conventional tympanoplasty and to evaluate and compare the graft uptake in both of these methods. The study was done to evaluate the improvement in hearing after tympanoplasty and the problems faced while doing the endoscope assisted tympanoplasty.Methods: Between July 2010 to June 2013, 50 patients underwent tympanoplasty, 25 were endoscope assisted (group A) and 25 were microscope assisted (group B). Results of surgery were compared at the end of three and six months post operation.Results: The success rate in terms of graft uptake rate was 88% with endoscope assisted tympanoplasty and 84% with other microscope assisted tympanoplasty. Overall success rate was 86.0%. Mean hearing improvement was (16.24±10.21 dB) and (14.28±7.10 dB) in group A and group B respectively.Conclusions: Tympanoplasty with its visualization of hidden corners, justifies tympanoplasty by using endoscope in selected cases with comparable improved results in the literature. Furthermore, the cost of the endoscope is much less (about 10%) in comparision to operating microscope, making it more cost effective in developing countries. However, the endoscope cannot be employed in every case as one hand is blocked. In terms of Patient comfort, the endoscope assisted outnumbers the benefits of other conventional methods.

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Epigastric pain after intravenous administration of oxytocin in patients undergoing lower segment cesarean section: A quasi experimental study comparing intravenous bolus with infusion technique

Anaesthesia, Pain & Intensive Care ◽

10.35975/apic.v24i1.1225 ◽

2020 ◽

Vol 24 (1) ◽

pp. 50-53

Author(s):

Ali Kashif ◽

Rizwana Bashir Kiani ◽

Syed Muhammad Asad Shabbir ◽

Tariq Mahmood ◽

Ghulam Sabir ◽

...

Keyword(s):

Experimental Study ◽

Cesarean Section ◽

Epigastric Pain ◽

Intravenous Bolus ◽

Lower Segment ◽

Lower Segment Cesarean Section ◽

Quasi Experimental ◽

Group A ◽

Group B ◽

Infusion Technique

Aim: To compare the frequency of epigastric pain and uterotonic effect of an equivalent dose of oxytocin administered as an intravenous bolus versus intravenous infusion during elective LSCS under spinal anesthesia. Methodology: We recruited 98 parturients undergoing elective LSCS under spinal anesthesia for this prospective quasi experimental study and divided them into two groups. Group-A received 5 IU of oxytocin as bolus intravenous (IV) injection in 5 sec (bolus group, n= 48), and Group-B (infusion group, n= 50) received 5 IU of oxytocin as an infusion over 5 min. Any complaint of epigastric pain by the patients was noted and its frequency was compared between the two groups. The uterine tone was assessed as adequate or inadequate by an obstetrician. The data were entered into SPSS version 22. Patient demographic data were analyzed with independent samples T-test and the study data were analyzed with Chi‑square test and presented as n (%). p < 0.05 was considered statistically significant. Results: Epigastric pain was noted in 25 (52.03%) out of 48 parturients in Group-A and 15 (30%) out of 50 in Group-B (p = 0.026). There was no significant difference in the uterotonic effect of oxytocin between the two groups (p = 0.736). Conclusion: We conclude that oxytocin infusion is associated with lower frequency of epigastric pain in elective LSCS when compared to intravenous bolus of an equivalent dose of oxytocin, However, the effect on uterine contractions was adequate with both methods. Citation: Kashif A, Kiani RB, Shabbir SMA, Mahmood T, Sabir G, Fatima NE, Khan WA. Epigastric pain after intravenous administration of oxytocin in patients undergoing lower segment cesarean section: A quasi experimental study comparing intravenous bolus with infusion technique. Anaesth pain intensive care 2020;24(1):_ DOI: https://doi.org/10.35975/apic.v2i1. Received – 20 February 2019; Reviewed – 4, 16 March, 25 June, 9 September, 2, 25 November, 10 December 2019, 7 January 2020; Revised – 19 June, 10 August, 29 September, 1 November 2019, 6 January 2020; Accepted – 10 January 2020;

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Fetal and Maternal Outcome Asymptomatic vs. Symptomatic Covid Positive Pregnant Women

10.53350/pjmhs2115103423 ◽

2021 ◽

Vol 15 (10) ◽

pp. 3423-3425

Author(s):

Amna Najam ◽

Samreen Fakeer Muhammad ◽

Samia Saifullah ◽

Maryam Shoaib ◽

Maria Anwar

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Cesarean Section ◽

Pregnant Women ◽

Apgar Score ◽

Adverse Outcomes ◽

Maternal Outcomes ◽

Group A ◽

Nicu Admission ◽

Group B

Objective: The aim of this study is to compare the fetal and maternal outcomes in between asymptomatic and symptomatic COVID positive pregnant women. Study Design: Retrospective cohort study Place and Duration: The study was conducted at Gynae and Obs department of Sandeman Provincial Hospital, Quetta for duration of six months from November 2020 to April 2021. Methods: One hundred and ten pregnant women with ages 18-45 years had corona virus disease were presented. Informed written consent was taken from all patients for detailed demographics. COVID -19 was diagnosed by PCR. 55 patients had symptoms of coronavirus were included in group A and 55 patients did not show symptoms were included in group B. Frequency of pre-eclampsia, gestational diabetes mellitus and post-partum haemorrhage were calculated. Maternal adverse outcomes (cesarean section, instrumental delivery, induction of labor and prolong labor, hypertensive disorder) were calculated among both groups. Fetal outcomes perinatal mortality, Low birth weight, Low Apgar score and NICU admission were observed. SPSS 20.0 version was used to analyze all data. Results: Mean age of the patients in group A was 28.47±3.18 years with mean BMI 24.03±5.24 Kg/m2 and in group B mean age was 27.99±4.17 years with mean BMI 24.44±6.41 Kg/m2. Maternal outcomes (cesarean section, instrumental delivery, induction of labor and prolong labor,) in symptomatic group were significantly higher than that of asymptomatic group. Fetal outcomes, perinatal mortality in group A 9 (16.4%) and in group B was 5 (9.1%), low birth weight in group A was among 21 (38.2%) and in group B was 10 (18.2%), low apgar score in group A was 11 (20%) and in group B was 8 (14.4%), 15 (27.3%) in group A went to NICU admission and 3 (5.5%) patient in group II admitted to NICU. Conclusion: In this study we concluded that adverse outcomes among symptomatic COVID pregnant women were higher than that of asymptomatic coronavirus pregnant women in terms maternal and perinatal outcomes. Keywords: Pregnant women, Coronavirus, Symptomatic, Asymptomatic, Adverse Outcomes

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The Treatment of Wrist Ganglion Cyst by the Chinese Acupotomy and Crisscross Thread

10.21203/rs.3.rs-94895/v1 ◽

2020 ◽

Author(s):

Shuliang Zhang ◽

Bin Xu ◽

Yangjun Lao ◽

Di Lu

Keyword(s):

Recurrence Rate ◽

Ganglion Cyst ◽

Combined Treatment ◽

Vas Score ◽

Ganglion Cysts ◽

Significant Difference ◽

Group A ◽

Group B ◽

The Cost ◽

Open Excision

Abstract Background: The current treatments of wrist ganglion have considerable recurrence rate, we developed a new treatment for ganglion cysts in our clinical practice, which combined acupotomy with crisscross thread method, so we now to compare the clinical effectiveness of Chinese acupotomy and crisscross thread with aspiration followed by injection of steroid and open excision for ganglion cysts treatment. Methods: Recruited patients with wrist ganglion were divided into three groups according to the treatments. Among them, 27 patients who were treated by a new combined treatment of Chinese acupotomy and crisscross thread method in group A, 30 patients who were treated by aspiration followed by steroid injection in group B, and 28 patients who were treated by open excision in group C. The data of age, gender, weight, size of ganglion cysts, visual analogue scale (VAS) , cost were recorded and compared by One-way analysis of variance, followed by an LSD (Least Significant Difference)test. The recurrence rates were recorded were analysed by chi-square test.Results: At the first day and one week after treatment, VAS score of group A was similar to group B with no statistic difference. VAS score of group C was higher than group A and B with statistic difference. Six months later, there was no statistic difference among the three groups about VAS. The recurrence rate was 3.7% in group A and 36.7% in group B and 10.7% in group C. No patient infected in three groups. The cost of group A was more than group B with no statistic difference. The cost of group A was much less than group C with statistic difference.Conclusions: The combination of Chinese acupotomy and crisscross thread method was a simple, economical and effective procedure for wrist ganglion cysts.

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