scholarly journals A prospective double blind randomized comparative study of safety and efficacy of Tapentadol versus Tramadol in post-operative orthopaedic patients

Author(s):  
Vasavi Gedela ◽  
Sashank Gururaj

Background: Pain following surgery is an unwanted effect which is to be relieved for the better outcome of surgery and anaesthesia. The study was conducted to compare the efficacy and safety of Tapentadol with Tramadol for post-operative pain relief in orthopaedic surgeries.Methods: After approval of IEC, patients of either sex aged between 18-55 years who had undergone orthopaedic surgeries at Government General Hospital, Kakinada between February 2013 to January 2015 were selected for study. It is a prospective double blind randomised active controlled parallel group comparative study. Sample size is 80 who fulfilled all criteria but there are 6 who discontinued drug in Tramadol group, so 74 were analysed. Written informed consent was taken from all patients, screening, pre anaesthetic evaluation done. Tablet Alprazolam 0.5mg was given at 9PM on previous day of surgery. Both Tramadol and Tapentadol were given 100mg orally 6th hourly. Pain intensity was analysed by visual analogue scale. Sedation was assessed with Modified Wilson sedation scale. Safety and tolerability was assessed by side effects reported by patients. Patients were assessed at 0, 2, 4, 6, 8, 10, 12, 18, 24, 30, 36, 42 and 48 hours post-operatively.Results: Pain reduction was higher in Tapentadol group on chi square test where p value is less than 0.001.Conclusions: Both Tramadol and Tapentadol are effective in treatment of post-operative pain. The pain reduction was higher in Tapentadol group on chi-square test where p value is <0.001. So, we can conclude from our study findings that Tapentadol is efficacious compared to Tramadol in reducing Post-operative pain. Both the drugs were well tolerated by the patients.

Author(s):  
Mallikarjuna Rao I. ◽  
Usha Kiran Prayaga ◽  
Dharma Rao Uppada ◽  
Ramachandra Rao E. ◽  
B. L. Kudagi

Background: The SSRIs being used as 1st line therapy in treatment of depression have delayed therapeutic effect which makes the patient vulnerable to an increased risk of suicide and decreased adherence to the treatment and will prematurely discontinue the therapy. The present study was conducted to evaluate if low dose mirtazapine-escitalopram combination therapy has any add on benefit over monotherapy with escitalopram.Methods: In a single-centered, comparative study involving patients with depression attending the out-patient after screening and exclusion, 60 eligible patients were randomly assigned to receive tablet mirtazapine 7.5 mg plus tablet escitalopram 10 mg intervention or tablet escitalopram 10 mg plus placebo intervention in a double-blind 6-week treatment phase. The primary outcome measure was the change in the 17-item Hamilton Depression Rating Scale (HDRS) and Montgomery-Asberg Depression Rating Scale (MADRS) score from baseline. Participants were evaluated at baseline, 1st, 2nd,4th and 6th week. Results were analyzed using Chi-Square test for adverse effects and independent t-test analysis for efficacy parameter.Results: In the analysis of results at 6th week the numbers of patients achieved remission in mirtazapine group are more with a p-value of 0.018 which is significant and the numbers of responders in mirtazapine group are also more which is statistically significant on chi-square test. There is no significant difference was observed between the two groups with reference to occurrence of adverse effect.Conclusions: Adding low dose mirtazapine has an added benefit in terms of efficacy and getting remission early with more number of responders in the treatment of major depression.


2017 ◽  
Vol 4 (10) ◽  
pp. 3392 ◽  
Author(s):  
Vinay G. ◽  
Balasubrahmanya K. S.

Background: Any skin closure technique aims at opposing the skin edges precisely without tension for sufficient time to allow healing to take place. The ease and speed with which the skin closure is completed, the level of patient discomfort, the complication rate, and the final cosmetic result are the factors which has to be considered in making a comparison of different types of wound closure. This study aims at comparing steristrips and subcuticular sutures for wound closure after thyroid surgery based on assessment of post-operative pain, neck mobility and cosmetic appearance.Methods: A comparative study was carried out among 90 subjects attending Department of Surgery, K. R. Hospital, Mysuru over a period of 10 months. Subjects of either sex undergoing thyroidectomy will be randomized to had their wounds closed by steristrips or subcuticular sutures using a simple randomization table. Patients who underwent previous neck irradiations, secondary neck surgeries, and patients with poor compliance were excluded from the study. Descriptive statistics, unpaired t-test and chi-square test were used to analyse the results.Results: The mean age group of the study subjects was 48.6 (range 24-76) years. The gender distribution showed a higher number of females (82) as compared to males (8). 70 patients were diagnosed with multinodular goitre, 16 patients were of thyroid neoplasms and 4 were of inflammatory thyroid conditions. 12 patients underwent subtotal thyroidectomy and 78 patients underwent total thyroidectomy. Wound closure by steristrips had less post-operative pain, acceptable neck mobility and excellent scar appearance as compared to subcuticular sutures.Conclusions: The choice of materials for wound closure will depend on the surgeon's preference. However, this study does show that steristrips sutures can be removed more quickly and is more acceptable method of wound closure as compared to subcuticular sutures after thyroid surgery.


2019 ◽  
Vol 35 (1) ◽  
Author(s):  
Faisal Nadeem ◽  
Muhammad Khan ◽  
Faheem Ullah Naz

Objective: The sub hepatic drain is often placed after laparoscopic cholecystectomy is considered to affect post operative infection, pain and sub hepatic collections. The objective of this study was to compare the degree of postoperative pain in patients with routine drainage with those without it after elective, uncomplicated laparoscopic cholecystectomy. Methods: This randomized control trial (RCT) was done over six months from 9th June 2015 to 8th December 2015 at Military Hospital Rawalpindi. Sample calculated with WHO calculator and consecutive non probability random sampling used to divide 170 patients undergoing laparoscopic cholecystectomy in two groups. One group had routine sub hepatic drain and other didn’t. Degree of postoperative pain was assessed according to VISUAL ANALOGUE SCALE by duty doctor at 24 hours. Data was collected and analyzed applying chi square test and p value was <0.05 considered statistically significant. Results: Our results demonstrated that intensity of post operative pain in routine drainage group is higher as compared to non drainage group after elective, uncomplicated laparoscopic cholecystectomy. Conclusion: Routine placement of sub hepatic drain in elective uncomplicated laparoscopic cholecystectomy should be avoided to reduce post-operative pain. How to cite this:Nadeem F, Khan MR, Naz FU. Comparison of mean pain scores for the patients with sub hepatic drainage to those without it after elective uncomplicated laparoscopic cholecystectomy. Pak J Med Sci. 2019;35(1):226-229. doi: https://doi.org/10.12669/pjms.35.1.224 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


2021 ◽  
Vol 18 (4) ◽  
pp. 753-757
Author(s):  
Ashis Pun ◽  
Amit Dhungana ◽  
Jewan Pariyar ◽  
Hari Prasad Upadhyay

Background: Endoscopic retrograde cholangiopancreatography is carried out under moderate sedation mostly by use of propofol, opioids and benzodizepines. The aim of study is to assess difficulty in cannulation of ampulla of vater with the use of fentanyl.Methods: A prospective randomized double blind comparative study was conducted at Bharatpur Hospital from August 2019 to August 2020 among patients undergoing Endoscopic retrograde cholangiopancreatography. Total 100 patients were enrolled in study and were divided in two groups – Group P (propofol and midazolam) and Group FP (propofol, midazolam and fentanyl). Ease of cannulation was determined using Freeman scale. Independent sample t-test was used to compare mean between two groups and Chi Square test was used to compare categorical variables.Results: Mean age (51.36±17.750 years versus 56.74±16.995 years), weight (58.88±8.151 kg versus 57.32±8.431 kg) and gender distribution (14 versus 12 male patients and 36 versus 38 female patients) were comparable in both groups-Group P and Group FP. There were 34 patients in Group P and 37 patients in Group FP with easy cannulation and 16 patients in Group P and 13 patients in Group FP with difficult cannulation, which was comparable (p value=0.509) Conclusions: Cannulation of ampulla of vater is not affected by the use of fentanyl in combination with propofol when compared to propofol alone and can be routinely used during endoscopic retrograde cholangiopancreatography.Keywords: Ampulla of vater; endoscopic retrograde cholangiopancreatography; fentanyl; propofol


1988 ◽  
Vol 16 (5) ◽  
pp. 338-348 ◽  
Author(s):  
P. Mastronardi ◽  
M. D'Onofrio ◽  
E. Scanni ◽  
M. Pinto ◽  
S. Frontespezi ◽  
...  

A controlled, parallel group study of the analgesic efficacy of flupirtine maleate, was compared against diclofenac sodium in 40 orthopaedic patients with post-operative pain. Clinically, both drugs were of equal analgesic efficacy. A mathematical model has been developed, however, to evaluate the speed, intensity and duration of the analgesic effect and provides data which significantly favour flupirtine maleate in the treatment of these patients.


2021 ◽  
Vol 16 (3) ◽  
pp. 144-147
Author(s):  
Bharat Ramchandra Sonawane ◽  

Background: Postdural puncture headache (PDPH) is a known complication of spinal anaesthesia. It is an iatrogenic cause,results after either intentional or accidental dural puncture.It begins typically within 2 days but regresses spontaneously in a few days. Present comparative study was conducted in patients who underwent elective lower abdominal surgery under spinal anaesthesia by midline or paramedian approach to evaluate incidence of postdural puncture headache at our tertiary hospital. Material and Methods: This prospective and comparative study was conducted 120 patients undergoing elective lower abdominal surgery under spinal anaesthesia were considered for present study. Patients were randomly divided in double‑blind fashion (patient and observer were blind to procedure) into two groups of 60 each. Numeric visual analog pain score was used to assess the postdural puncture headache in both the groups. Any case of persistent postdural puncture backache after discharge was followed up to 7 days through telephonic communication with the patient. The data collected was analysed statistically. Quantitative variables were expressed as Mean ± SD (standard deviation) while qualitative variables were expressed as relative frequency and percentage. The PDPH was analysed using Chi square test. P-value <0.05 was considered as statistically significant. Results:120 patients undergoing elective lower abdominal surgery under spinal anaesthesia were randomly divided in double‑blind fashion (patient and observer were blind to procedure) into two groups as Group M (median approach) and Group P (paramedian approach) of 60 patients each. General characteristics such as age, weight, gender and ASA status were comparable in both groups. Intra-operative hypotension was noted in 10% patients of group M and 8% patients of group P, difference was not statistically significant. 3 % patients of group M and group P required medications (tramadol / paracetamol) to treat PDPH.In present study postdural puncture headache was mild in 8 % and moderate in 3% patients in group M. While 7% patients had mild and 3% patients had moderate postdural puncture headache in group P. Incidence of postdural puncture headache was 10% in group M and 8% in group P, difference was not statistically significant. Conclusion: There was no difference regarding the incidence of PDPH in median and paramedian approach for spinal anaesthesia.


Author(s):  
Dina AbdelHamid ◽  
Amal H.A. Gomaa ◽  
Ghada F. Mohammed ◽  
Moustafa M. K. Eyada ◽  
Mohamed Aly El_Sweify

Background: Onychomycosis is a fungal infection that affects toenails or fingernails and may involve any component of the nail unit. Tea tree oil (TTO), or Melaleuca oil, is a pale yellow to nearly colorless, clear oil with a fresh camphoraceous odor that has antifungal effect if used from 5-100% concentration according to site of fungal affection. Aim: This study aimed to provide a new line for treatment of onychomycosis. Patients and methods: A randomized double blind interventional cohort prospective effectiveness trial, in which 66 patients with onychomycosis were recruited after their written consent was obtained. Patients on local or systemic treatment or with coexisting inflammatory skin disease were excluded. TTO efficacy in treatment of onychomycosis was evaluated by application of 100% TTO for 6 months with pre and post treatment nail culturing. Results: After 6 months treatment with TTO, 27% of patients were completely cured, 65% were partially cured and 8% had no response according to appearance of the index nail (the nail with the greatest fungal burden at the time of entry into the study). Calculation of P value by Chi-Square test, it equal 0.001 which is highly significant. Conclusion: TTO may play a role in treatment of onychomycosis without side effects of medications or surgical hazards caused by surgery.


2018 ◽  
Vol 1 (1) ◽  
pp. 34
Author(s):  
Ni Nyoman Novita ◽  
Gusman Arsyad

Implementation of IMD in hospitals has decreased from the previous year and has not reached the target set by the government. Some IMD implementation processes have not been carried out according to applicable standards. So that babies do not get an IMD in accordance with existing SOPs. The purpose of this study was to determine the determinant factors associated with the implementation of the IMD by midwives in the Midwifery and Maternity Room Emergency Room (IGD) at the Anutapura General Hospital in Palu. This research method is analytical with cross sectional approach. The population of this study was that all midwives in the obstetrics emergency room and maternity room at Anutapura Palu Hospital were 37 respondents. The sample in this study is total sampling. The analysis used was univariate, and bivariate analysis using the chi square test with a confidence level of 95% (α = 0.05). The results of statistical tests on variable knowledge of midwives with the implementation of IMD p value: 0.018 (p value <0.05). APN training with the implementation of IMD p value: 0.697 (p value> 0.05). length of work with the implementation of IMD p value: 0.029 (p value <0.05). and peer support with the implementation of IMD p value: 0.007 (p value <0.05). Conclusions there is a relationship between knowledge, length of work, peer support with the implementation of the IMD, and training factors that have nothing to do with IMD implementation. The strongest factor in the relationship is peer support. It is recommended that the Anutarapura Palu Hospital be able to motivate midwives so that they can further enhance their role in the implementation and provide support to their colleagues so that the implementation of the IMD can be carried out in accordance with applicable standards.Keywords: Knowledge, APN Training, Duration of work, Implementation of IMD


Author(s):  
Desti Widya Astuti Desti Widya Astuti

ABSTRAK   Berdasarkan data di RSUD Kota Prabumulih bahwa terdapat peningkatan jumlah kejadian perdarahan post partum, tahun 2014 sebanyak 178 orang, tahun 2015 sebanyak 246 orang dan tahun 2016 sebanyak 151 orang. Penelitian ini bertujuan untuk mengetahui hubungan umur ibu dan jarak kehamilan terhadap kejadian perdarahan post partum di RSUD Kota Prabumulih Tahun 2016. Penelitian ini merupakan penelitian analitik dengan rancangan cross sectional. Populasi yang digunakan adalah semua ibu bersalin di RSUD Kota Prabumulih, sebanyak 1.296 ibu bersalin dan 306 sampel. Pengambilan sampel dengan mengunakan random sampling, analisa data menggunakan analisa univariat dan bivariat dengan menggunakan uji statistik chi-square dengan derajat kemaknaan 0,05. Hasil penelitian ini menunjukan bahwa dari 288 ibu bersalin terdapat 151 yang mengalami perdarahan post partum sebagian besar adalah ibu dengan umur resiko tinggi sebanyak 43 orang  (40,9%) dan ibu dengan jarak kehamilan resiko tinggi sebanyak 21 orang (17,3%). Hasil uju chi-square umur didapatkan p.value 0,000 < α 0,05 dan uji chi-square untuk jarak kehamilan didapatkan p.value 0,000 < α 0,05. Maka ada hubungan umur ibu dan jarak kehamilan terhadap kejadian perdarahan post partum di RSUD Kota Prabumulih Tahun 2016. ABSTRACK   Based on the data at District General Hospital (RSUD) Prabumulih, there was increasing of post-partum bleeding, in 2014, there were 178 people. In 2015, there were 246 people. And in 2016, there were 151 people. The purpose of the study was to know relationship between maternal mother and the distance and old post-partum bleedingat District General Hospital (RSUD) Prabumulih in 2013. The study was analytic researchwith cross sectional design. Population thas was used in the study was all maternal mother ar District General Hospital (RSUD) Prabumulih. It was about 1.296 maternal mother and from 306. Random sampilng was done in the study, data analyses used univariate and bivariate analyses by using chi-square statistic test with significance level 0,05. The study result showed that from 306 maternal mother, there were 151 mother who experienced old post-partum bleeding, the large of that was high maternal mother 43 people  (40,9%) and mother age high distance 21 people (17,3%). The result of chi-square test was p value 0,000 < α 0,05 and chi-square test for age was p value 0,000 < α 0,05. It meant that there was relationship between maternal mother and the distance and of post-partum bleeding at District General Hospital (RSUD) Prabumulih in 2016.


Author(s):  
Wahyu Ida Muliana Wahyu Ida Muliana

ABSTRACT Hyperemesis Gravidarum marked excessive nausea and vomiting in pregnant women at a young age. WHO estimates that 536,000 women died from direct complications of pregnancy and childbirth. One complication of pregnancy is Hyperemesis Gravidarum. Hyperemesis Gravidarum in the world has been estimated to occur in 1-2% of pregnant. According to data from the Medical Record of Dr. Mohammad Hoesin Palembang Hospital, the incidence of Hyperemesis Gravidarum in 2011 there were 72 people of 661 pregnant women. The purpose of this reseach was to determine the relationship between maternal age and parity with Hyperemesis Gravidarum in Dr. Mohammad Hoesin Palembang Hospital 2011. The Design of this reseach used Cross Sectional by analytic approach survey. The population of this reseach are all of mother who gestational ≤ 16 weeks (four months) in the Installation of Obstetrics and Gynecology, Dr. Mohammad Hoesin Palembang Hospital in January to December of 2011 with the sample of 661 people which taken by systematic random sampling and the reseach was conducted from 17 April to 24 April 2012.  Each variable that was observed in tests using Chi-Square test with a (0.05).  The results of this study showed that 5.9% of mothers with hyperemesis gravidarum, 21.8% of mothers with high risk age, and 30.0% primigravida. Chi-Square test showed no significant relationship between age (p value = 0.000) and parity (p value = 0.000) with the incidence of hyperemesis gravidarum. Expected to the Hospital to be implemented properly instructed how to provide counseling to pregnant women about pregnancy and childbirth, as well as provide confidence that the nausea and vomiting is a symptom of physiology in pregnancy.   ABSTRAK Hiperemesis Gravidarum ditandai mual dan muntah yang berlebihan terjadi pada ibu hamil di usia muda. WHO memperkirakan 536.000 perempuan meninggal dunia akibat langsung dari komplikasi kehamilan dan persalinan. Salah satu komplikasi kehamilan adalah Hiperemesis Gravidarum. Insiden Hiperemesis Gravidarum di dunia telah diperkirakan terjadi pada 1-2% wanita hamil. Menurut data dari Medical Record Rumah Sakit Umum Pusat Dr. Mohammad Hoesin Palembang, angka kejadian Hiperemesis Gravidarum pada tahun 2011 terdapat 72 orang dari 661 ibu hamil. Tujuan penelitian ini adalah untuk mengetahui hubungan antara umur dan paritas ibu dengan kejadian Hiperemesis Gravidarum pada ibu di Rumah Sakit Umum Pusat Dr. Mohammad Hoesin Palembang tahun 2011. Desain Penelitian ini menggunakan survei analitik dengan pendekatan Cross Sectional. Populasi penelitian ini adalah dengan umur kehamilan ≤ 16 minggu (4 bulan) yang pernah dirawat inap di Instalasi Kebidanan dan Penyakit Kandungan Rumah Sakit Umum Pusat Dr. Mohammad Hoesin Palembang pada bulan Januari-Desember tahun 2011 dengan jumlah sample 661 orang yang diambil secara systematic Random Sampling (secara acak sistematis) dan penelitian ini dilakukan dari tanggal 17 April sampai dengan 24 April 2012. Masing-masing variabel yang diteliti di uji dengan menggunakan uji Chi-Square dengan a (0,05). Hasil penelitian ini menunjukkan bahwa 5,9% ibu mengalami hiperemesis gravidarum, 21,8% ibu dengan umur resiko tinggi, dan 30,0% ibu primigravida. Uji Chi-Square menunjukkan ada hubungan yang bermakna antara umur (p value = 0,000) dan paritas (p value = 0,000) dengan kejadian hiperemesis gravidarum. Diharapkan dapat menjadi masukan bagi pihak Rumah Sakit agar dilaksanakan penyuluhan dengan cara memberikan konseling terhadap ibu hamil tentang kehamilan dan persalinan, serta memberikan keyakinan bahwa mual muntah merupakan gejala fisiologi pada kehamilan.


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