The spinal adjuvent - intrathecal nalbuphine as effective as intrathecal fentanyl

Opioids are favoured as adjuvants to local anaesthetics for spinal anaesthesia. The present study was aimed to compare the clinical efficiency of intrathecal nalbuphine with fentanyl as an adjuvant to 0.5% hyperbaric bupivacaine. 100 adult patients of either sex, ASA grade I and II, aged 18–60 years were randomized into two groups of 50 each to receive either fentanyl 25 μg (Group BF) or nalbuphine 500µg (Group BN) with 3 ml 0.5% hyperbaric bupivacaine, making drug volume to 3.5 ml in each group. Sensory and motor block characteristics, duration of analgesia, VAS score, haemodynamic and side effects were recorded. The sensorimotor characteristics were comparable and found no significant difference between the two groups, (P>0.05). The time duration for adequate analgesia in group BN was 366.40 ± 37.32min, and in the group, BF was 361.39 ± 43.96min, (P= 0.567). In both, the groups, quality of analgesia during the procedure was excellent in a maximum number of patients (96% each group). Sedation score, hemodynamic and respiratory rate changes were comparable between the two groups. In group BF, 4 (8%) patients complained nausea/ vomiting, pruritus was observed in 2 (4%), intraoperative hypotension in 3 (6%) and bradycardia in 2 (4%) and post-dural puncture headache in 2 patient (4%). In group BN, only bradycardia was observed in 3 (6%) patients. Nalbuphine and fentanyl were found to be equally efficient, but nalbuphine had a lower side effect profile, readily available as it does not come under the Narcotic act. However, we suggest Nalbuphine-bupivacaine combination as a better alternative than fentanyl-bupivacaine combination.

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The Sprotte Needle and Post Dural Puncture Headache following Caesarean Section

Anaesthesia and Intensive Care ◽

10.1177/0310057x9302100303 ◽

1993 ◽

Vol 21 (3) ◽

pp. 280-283 ◽

Cited By ~ 10

Author(s):

A. W. Ross ◽

C. Greenhalgh ◽

D. P. McGlade ◽

I. G. Balson ◽

S. C. Chester ◽

...

Keyword(s):

Caesarean Section ◽

Population Size ◽

Lower Incidence ◽

Dural Puncture ◽

Operating Conditions ◽

Hyperbaric Bupivacaine ◽

Post Dural Puncture Headache ◽

The Difference ◽

Obstetric Population

One hundred and forty-four patients receiving subarachnoid anaesthesia for caesarean section were prospectively analysed for quality of anaesthesia and the occurrence of post dural puncture headache (PDPH). Anaesthesia was administered via 24 gauge Sprotte (n = 104) and 26 gauge Quincke (n = 40) needles using hyperbaric bupivacaine 0.5% with morphine 0.2 mg. Anaesthesia was successful in 103 patients with the Sprotte needle and 38 patients with the Quincke needle, and the operating conditions were considered to be excellent. Of the 104 patients in the Sprotte needle group there were ten with PDPH (9.6%), two of which were considered severe. Of the 40 patients in the Quincke needle group there were eight with PDPH (20%), three of which were considered severe. Despite the lower incidence of headache in the Sprotte needle group, this was not statistically significant (P>0.05), due to the difference in population size. We conclude that the 24 gauge Sprotte needle is associated with a comparatively low but clinically relevant incidence of headache in the obstetric population.

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Comparison between Nalbuphine and Ketamine as an adjuvant to Heavy Bupivacaine on Post Dural Puncture Headache

QJM ◽

10.1093/qjmed/hcab086.060 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mohammad A El Gendy ◽

Gamal M Elewa ◽

Mina Z Wadea ◽

Ashraf M Hazem

Keyword(s):

Spinal Anesthesia ◽

Normal Saline ◽

Dural Puncture ◽

Sensory Block ◽

Saline Group ◽

Controlled Study ◽

Normal Saline Group ◽

Hyperbaric Bupivacaine ◽

Post Dural Puncture Headache ◽

Significant Difference

Abstract Background Incidence of post dural puncture headache (PDPH) is relatively high, and many methods have been tried to prevent or treat it, but results are not satisfactory. Both Nalbuphine and Ketamine have analgesic effects, and have been used intrathecally with local anesthetics, but their effects on PDPH were not studied. Objective To study the incidence and severity of PDPH when nalbuphine or ketamine was added as an adjuvant to hyperbaric bupivacaine in spinal anesthesia (primary outcome). Secondary outcomes were the effects of adding nalbuphine or ketamine as an adjuvant to hyperbaric bupivacaine on motor and sensory effects, duration of analgesia, hemodynamics and side effects of both of them. Patients and Methods This prospective double-blind, randomized controlled study was conducted on 320 patients, aged 21–60 years of both sexes, ASA physical status I and II, and allocated for lower abdominal, pelvic, or lower limb surgeries under spinal anesthesia, after approval from ethical committee (Assurance No. FWA 000017585) of Faculty of Medicine, Ain, Shams University, Cairo, Egypt. Contact with 17 patients was lost. So, 303 patients completed the study. Patients were divided into 3 equal groups (101 each) according to drugs injected intrayhecally. Group (N): 3 ml of 0.5% hyperbaric bupivacaine with 0.5 mg nalbuphine hydrochloride diluted in 0.5 ml normal saline. Group (K): 3 ml of 0.5% hyperbaric bupivacaine with 25 mg ketamine hydrochloride diluted in 0.5 ml normal saline. Group (C): 3 ml of 0.5% hyperbaric bupivacaine with 0.5 ml normal saline. Results Incidence of PDPH was statistically significantly less in group N in comparison to Groups K and C, in the first day. But, no statistically significant difference was found between the three groups at 2nd and 3rd days. There was no statistically significant difference between groups according to severity of PDPH by visual analog score (VAS). Group N has the most rapid onset and long duration of sensory block in comparison with groups K and C. There was no statistically significant difference between groups according to onset and duration of motor block and hemodynamic changes. Conclusion Adding nalbuphine, and not ketamine, with hyperbaric bupivacaine in spinal anesthesia decreased incidence of post dural puncture headache, and prolonged the duration of sensory block. Both groups provided adequate anesthesia and analgesia with good hemodynamic stability.

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What is the knowledge of tubercular patients about risk factors contributing to development of their disease

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh06s2122i ◽

2006 ◽

Vol 134 (Suppl. 2) ◽

pp. 122-127 ◽

Cited By ~ 1

Author(s):

Miroslav Ilic

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Main Risk Factor ◽

Active Pulmonary Tuberculosis ◽

Anonymous Questionnaire ◽

Number Of Patients ◽

Significant Difference ◽

Level Of Knowledge ◽

Basic Characteristics

INTRODUCTION. Present knowledge of population on basic characteristics of tuberculosis is a significant issue of prevention of tuberculosis. OBJECTIVE. The objective of our study was to determine the level of knowledge on risk factors of tuberculosis among tubercular patients. METHOD. A total of 115 new patients with the active pulmonary tuberculosis were interviewed by means of anonymous questionnaire, who has been treated at the Institute of Pulmonary Diseases, Sremska Kamenica during six-month period (October 2003-March 2004). RESULTS. The patients fulfilled the questionnaire; 37.6 % had no or finished only elementary school, and 58.6 % considered genetics the main risk factor of tuberculosis. Every second patient believed that he could not catch tuberculosis if he suffered from diabetes mellitus or any kind of tumor. 8.7 % of patients who suffered from diabetes mellitus had been informed by their physicians that could catch tuberculosis one day. Every third patient did not possess sewage system and nearly 20% lived in moist flats. Around 85% had no regular salaries or these were significantly under the average Serbian income per capita in this period (12820 dinars-CSD). Leading risk factors that can contribute to development of tuberculosis were as follows: irregular nutrition (91.4 %), smoking (74.2 %), alcohol consumption (65.5%) and associated diseases (diabetes mellitus, tumors). Only 15% of them believed that all these risk factors (smoking, alcohol, irregular diet) could participate together in development of tuberculosis, and not as individual factors. Analyzing the patients? knowledge on risk factors of tuberculosis, in relation to their educational level and alcohol and cigarettes consumption, there was no significant difference (p<0.05). Nevertheless, analyzing the quality of life in patients? houses, in relation to salary and bad habits (alcohol, cigarettes) as risk factors of tuberculosis, significant statistical difference was found (p>0.05). CONCLUSION. Intensive and permanent education of population is necessary primarily considering the knowledge on tuberculosis that would be the basis of reducing the number of patients and leading to possible eradication of this disease.

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Clinical benefits of preemptive oral clonidine versus oral tramadol for abdominal hysterectomy conducted under subarachnoid block with 0.5% hyperbaric bupivacaine: a comparative evaluation

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20173001 ◽

2017 ◽

Vol 5 (7) ◽

pp. 3129

Author(s):

Kumkum Gupta ◽

Swati Sharma ◽

Prashant K. Gupta ◽

Guljeet Kaur ◽

Vasundra Tyagi ◽

...

Keyword(s):

Muscle Relaxation ◽

Abdominal Hysterectomy ◽

Hyperbaric Bupivacaine ◽

Subarachnoid Block ◽

Oral Clonidine ◽

Significant Difference ◽

Clinical Benefits ◽

Intraoperative Period ◽

American Society ◽

To Receive

Background: Neuraxial techniques possess many benefits for elective abdominal hysterectomy due to profound surgical anesthesia and muscle relaxation. The present study was aimed to compare the clinical benefits of pre-emptive oral clonidine with oral tramadol for abdominal hysterectomy conducted under subarachnoid block with 0.5% hyperbaric bupivacaine.Methods: Sixty adult female patients of American Society of Anaesthesiologists (ASA) physical status I and II, aged 42 to 65 years, were randomized into two groups of 30 patients each to receive either oral clonidine, 100 µg (Group C) or oral tramadol 50 mg tramadol (Group T), 90 min before initiation of subarachnoid block with 3.5 mL of 0.5% hyperbaric bupivacaine. Intraoperative hemodynamic changes, duration of analgesia and incidence of shivering were recorded as primary end points. Drug related effects of pruritus, sedation, nausea, vomiting, and respiratory depression were recorded as secondary outcomes.Results: The onset of sensory and motor block was comparable between the groups but the time to two dermatome regression were prolonged in patients of Group C with statistical significant difference (p=0.05). Duration of analgesia was also enhanced in patients of Group C (268.27±12.18 min versus 223.15±14.31 min in Group T) with statistically highly significant difference (p=0.000). The incidence of shivering was lower in the patients of clonidine group. The heart rate was lower in patients of clonidine throughout intraoperative period and no incidence of bradycardia, hypotension or sedation occurred in any patient.Conclusions: Both drugs showed clinical benefits as pre-emptive oral medication for abdominal hysterectomy conducted under subarachnoid block but oral clonidine (100 µg) proved to be more beneficial.

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Conducting Goals-of-Care Discussions Takes Less Time Than Imagined

JCO Oncology Practice ◽

10.1200/jop.19.00743 ◽

2020 ◽

Vol 16 (12) ◽

pp. e1499-e1506

Author(s):

Sofya Pintova ◽

Ryan Leibrandt ◽

Cardinale B. Smith ◽

Kerin B. Adelson ◽

Jason Gonsky ◽

...

Keyword(s):

Cancer Progression ◽

High Quality ◽

Goals Of Care ◽

Coaching Model ◽

Face To Face ◽

Significant Difference ◽

Encounter Time ◽

Face Time ◽

To Receive

PURPOSE: To describe the length of encounter during visits where goals-of-care (GoC) discussions were expected to take place. METHODS: Oncologists from community, academic, municipal, and rural hospitals were randomly assigned to receive a coaching model of communication skills to facilitate GoC discussions with patients with newly diagnosed advanced solid-tumor cancer with a prognosis of < 2 years. Patients were surveyed after the first restaging visit regarding the quality of the GoC discussion on a scale of 0-10 (0 = worst; 10 = best), with ≥ 8 indicating a high-quality GoC discussion. Visits were audiotaped, and total encounter time was measured. RESULTS: The median face-to-face time oncologists spent during a GoC discussion was 15 minutes (range, 10-20 minutes). Among the different hospital types, there was no significant difference in encounter time. There was no difference in the length of the encounter whether a high-quality GoC discussion took place or not (15 v 14 minutes; P = .9). If there was imaging evidence of cancer progression, the median encounter time was 18 minutes compared with 13 minutes for no progression ( P = .03). In a multivariate model, oncologist productivity, patient age, and Medicare coverage affected duration of the encounter. CONCLUSION: Oncologists can complete high-quality GoC discussions in 15 minutes. These data refute the common misperception that discussing such matters with patients with advanced cancer requires significant time.

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Comparison of Ondansetron with Gabapentin for prevention of intrathecal morphine induced pruritus

Medical Journal of Pokhara Academy of Health Sciences ◽

10.3126/mjpahs.v2i3.26109 ◽

2019 ◽

Vol 2 (3) ◽

pp. 142-148

Author(s):

Rohini Sigdel ◽

Anil Shrestha ◽

Roshana Amatya

Keyword(s):

Single Dose ◽

Intrathecal Morphine ◽

Double Blind Study ◽

Physical Status ◽

Hyperbaric Bupivacaine ◽

Double Blind ◽

Subarachnoid Block ◽

Significant Difference ◽

Group 2 ◽

To Receive

Background: Ondansetron has been used successfully for prophylaxis and treatment of intrathecal morphine induced pruritus. Gabapentin has anxiolytic, antiemetic, antipruritic effects and has also been shown to potentiate the analgesic effect of intrathecally or epidurally administered opioids. Materials and method: We compared the effectiveness of oral gabapentin with intravenous ondansetron to prevent incidence of intrathecal morphine induced pruritus. In a prospective, double-blind study, sixty patients aged 18-65 years with ASA physical status I and II undergoing surgery under subarachnoid block were randomized to receive placebo tablets (ondansetron group) or gabapentin 1200 mg (gabapentin group) 2 hours before surgery. Patients receiving placebo tablets received 8 mg of intravenous ondansetron and those receiving gabapentin received 4 ml of intravenous normal saline just prior to subarachnoid block with 3 ml of 0.5% hyperbaric bupivacaine plus 0.2 mg morphine. The incidence, onset, severity, location of pruritus and incidence of side effects were studied for next 24 hours. Results: The overall incidence of pruritus was 48.3%. The incidence, severity, location of pruritus was comparable between the two groups. There was significant difference between the onset of pruritus between groups (p=0.009). The incidence and grade of nausea vomiting, requirement of intraoperative sedation was comparable between groups. The incidence of urinary retention was significantly high in gabapentin group (p=0.020). Respiratory depression was observed in one patient. Conclusion: A single dose of 1200 mg oral gabapentin 2 hours before, is as effective as prophylactic intravenous ondansetron 8 mg for prevention of intrathecal morphine induced pruritus.

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Prospective evaluation of epoetin-alfa (EA) vs epoetin-beta (EB) vs darbepoetin (DE) in anemic cancer patients (pts) receiving chemotherapy (CT): Early results of an independent observational survey by the Italian ReVERTO network

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.18548 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 18548-18548

Author(s):

C. F. Pollera ◽

F. Nelli ◽

T. Gamucci ◽

I. Sperduti ◽

A. M. Giampaolo ◽

...

Keyword(s):

Treatment Schedule ◽

Weekly Schedule ◽

Severe Anemia ◽

Treatment Groups ◽

Therapy Efficacy ◽

Early Results ◽

Significant Difference ◽

To Receive ◽

Major Data

18548 Background: Direct comparison of EA vs EB vs DE has never been performed. In order to define the efficacy, impact on quality of life (QL) and pt’s preference, a prospective observational comparison of erythropoietic agents has been carried out. Methods: Anemic pts (hgb <11 gr/dL) scheduled to receive at least 3 cycles of CT were stratified according to 5 factors (platinum-based CT vs non-platinum; hgb ≤9,5 vs >9,5; PS ≤0–1 vs >1; previous CT vs upfront CT; and previous antianemic therapy vs not) and were autonomously assigned by 15 investigators to EA (3 times a week) or EB (3 times a week and only in pts receiving platinum-based CT) or DE (once a week) therapy. Efficacy by hgb level changes and transfusion needing was evaluated after each cycle of CT, QL by Fact-An questionnaire after 1 and 3 cycles of CT, and pt’s preference for standard vs weekly schedule at least once thereafter. Results: From 09/04 to 12/05 177 pts were recruited: 41%, 39% and 20% were assigned to DE, EA and EB, respectively. Severe anemia at baseline (≤9,5) was reported in 29% of pts, whereas 47% received platinum-based CT. Stratifying categories were well balanced among the treatment groups. Baseline mean hgb values were 9.7, 9.9, and 10 for DE, EA and EB, respectively. As of the general population, DE produced higher subsequent mean hgb increase in respect to EA and EB (Mean increase [gr/dL] for DE: 0.84, 1.58, 2.03; EA: 0.34, 0.84, 1.68; EB: 0.76, 1.54, 1.17). No difference was observed neither among pts receiving platinum-based CT, (mean increase: DE: 0.34, 1.76, 2.8; EA: 0.7, 1.27, 2.14; EB: 0.76, 1.54, 1.71) nor among pts with severe anemia at baseline (DE: 0.98, 2, 2.6; EA: 1.24, 1.94, 3.13; EB: 1.25, 2.25, 2.75). Transfusion needing ranged from 7% for DE to 3% for EB without any significant difference. To date 67% of pts completed at least one subsequent QL valuation, whereas 62% gave their preference for treatment schedule. Conclusions: Early results of our prospective analysis show that antianemic therapy with D is at least as effective as standard schedule of EA or EB. Efficacy of DE seems confirmed in pts with bad prognostic categories for anemia. Major data on QL and pt’s preference will be presented. No significant financial relationships to disclose.

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Melphalan and prednisone plus thalidomide or placebo in elderly patients with multiple myeloma

Blood ◽

10.1182/blood-2009-08-237974 ◽

2010 ◽

Vol 116 (9) ◽

pp. 1405-1412 ◽

Cited By ~ 175

Author(s):

Anders Waage ◽

Peter Gimsing ◽

Peter Fayers ◽

Niels Abildgaard ◽

Lucia Ahlberg ◽

...

Keyword(s):

Multiple Myeloma ◽

Partial Response ◽

Controlled Study ◽

Plateau Phase ◽

Life Outcomes ◽

Double Blind ◽

Skin Reactions ◽

Significant Difference ◽

To Receive

Abstract In this double-blind, placebo-controlled study, 363 patients with untreated multiple myeloma were randomized to receive either melphalan-prednisone and thalidomide (MPT) or melphalan-prednisone and placebo (MP). The dose of melphalan was 0.25 mg/kg and prednisone was 100 mg given daily for 4 days every 6 weeks until plateau phase. The dose of thalidomide/placebo was escalated to 400 mg daily until plateau phase and thereafter reduced to 200 mg daily until progression. A total of 357 patients were analyzed. Partial response was 34% and 33%, and very good partial response or better was 23% and 7% in the MPT and MP arms, respectively (P < .001). There was no significant difference in progression-free or overall survival, with median survival being 29 months in the MPT arm and 32 months in the MP arm. Most quality of life outcomes improved equally in both arms, apart from constipation, which was markedly increased in the MPT arm. Constipation, neuropathy, nonneuropathy neurologic toxicity, and skin reactions were significantly more frequent in the MPT arm. The number of thromboembolic events was equal in the 2 treatment arms. In conclusion, MPT had a significant antimyeloma effect, but this did not translate into improved survival. This trial was registered at www.clinicaltrials.gov as #NCT00218855.

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Perbandingan Tingkat Sedasi Klonidin Syrup 2 mcg/kgBB dengan Diazepam Syrup 0.4 mg/kgBB sebagai Premedikasi pada Pasien Anak yang Menjalani Pembedahan dengan General Anestesi

Jurnal Ilmu Kedokteran ◽

10.26891/jik.v5i2.2011.111-117 ◽

2017 ◽

Vol 5 (2) ◽

pp. 111

Author(s):

Vera Muharrami ◽

A. Sani P. Nasution ◽

Nazaruddin Umar

Keyword(s):

Pediatric Surgery ◽

Optimal Dose ◽

Controlled Clinical Trial ◽

Subjective Feeling ◽

Double Blind ◽

Adrenoceptor Agonist ◽

Number Of Patients ◽

Significant Difference ◽

Preanesthetic Medication

Introduction: Anxiety in children undergoing surgery is characterized by subjective feeling of tension, apprehension,nervousness and worry that may be expressed in various forms. Clonidine, an alpha 2-adrenoceptor agonist, has beenshown to be as a preanesthetic medication in childrens. The current study was designed to investigate the differencesof level sedation clonidine syrup and diazepam syrup as a premedicant in children.Methods: In a randomized, double-blind, controlled clinical trial, 40 children, aged 2-12 yr, undergoing electivesurgery received 2 micrograms/kg clonidine syrup or 0.4 mg/kg diazepam syrup orally. These agents were administered120 min before the estimated time of induction of general anesthesia and noted the children’s level of sedation. Thelevel of sedation were compared among the two groups. PASS <1 demanded rescue intravenous sedation.Result: Clonidine syrup 2 mcg/kgBB provided better quality of sedation after 60 min of premedicant but it wasn’tsignificant(1.8±0.92) and diazepam syrup (0.80±0.89; p>0.05) and number of patients with rescue intravenous diazepamacceptance were same both clonidine group compared to diazepam, there was no significant difference between twogroups, 10% of clonidine group patients, 10 % of diazepam group patients (p>0.05). No clinically significanthypotension or bradycardia was observed after preanesthetic medications of diazepam and clonidine syrup.Discussion: These data indicate that, even in pediatric surgery, the 2 micrograms/kg syrup clonidine is an effectivepremedication. However, the safety and optimal dose of clonidine in this setting remain to be determined.

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Efektivitas Pemberian Edukasi Berbasis Audiovisual dan Tutorial Tentang Antiretroviral (ARV) Terhadap Kepatuhan Pengobatan pada Pasien HIV/AIDS di Klinik Teratai Rumah Sakit Hasan Sadikin Bandung Tahun 2016

The Indonesian Journal of Infectious Diseases ◽

10.32667/ijid.v3i2.35 ◽

2017 ◽

Vol 3 (2) ◽

pp. 38

Author(s):

Sinta Fresia

Keyword(s):

Quality Of Life ◽

Control Group ◽

Research Use ◽

Social And Emotional ◽

Number Of Patients ◽

Significant Difference ◽

Quasi Experimental ◽

The Difference ◽

Hiv Aids

Abstrak Latar Belakang : Terjadinya peningkatan jumlah pasien HIV/AIDS dan rendahnya kualitas hidup pasien HIV/AIDS menimbulkan masalah yang cukup luas pada individu yang terinfeksi yakni masalah fisik, social dan emosional.Untuk meningkatkan kualitas dan harapan hidup pasien HIV/AIDS harus mendapatkan terapi Antiretrovirus (ARV) seumur hidup dan dibutuhkan pengawasan terhadap kepatuhan minum obat.Oleh karena itu pasien HIV/AIDS membutuhkan edukasi untuk meningkatkan kepatuhan minum obat dengan metode terbaru yaitu tutorial dan audiovisual.Tujuan penelitian ini untuk menganalisa perbedaan efektivitas pemberian edukasi berbasis audiovisual dan tutorial tentang ARV terhadap kepatuhan pengobatan pasien HIV/ AIDS. Metode : Penelitian ini menggunakan desain Quasi eksperimental dengan rancangan pretest-posttes design without control group.Jumlah sampel 27 responden dibagi 3 kelompok dengan 3 perlakuan berbeda.Masing-masing 9 responden diberikan edukasi dengan metode audiovisual, tutorial, audiovisual dan tutorial.Penelitian dilakukan di Klinik Teratai Rumah Sakit Hasan Sadikin Bandung pada bulan Mei-Juni 2016. Hasil : Ada perbedaan rata-rata mean kepatuhan edukasi dengan audiovisual 2,444, (Pvalue=0,003, 95% CI=1,107-3,782), edukasi dengan metode tutorial perbedaan mean 1,556 (Pvalue=0,023, 95% CI=1,274-2,837), edukasi dengan audiovisual dan tutorial didapatkan perbedaan mean 3,667 (Pvalue=0,003, 95% CI=1,670-5,664). Kesimpulan : Terdapat perbedaan yang significant rata-rata kepatuhan pada masing-masing kelompok intervensi edukasi.Kombinasi edukasi berbasis audiovisual dan tutorial memberikan hasil yang paling baik. Abstract Background : An increasing number of patients with HIV/AIDS and low quality of life of patients with HIV/AIDS cause considerable problems in individuals infected area.There are physical, social and emotional problems.To improve the quality of life of receive antiretroviral (ARV) therapy for life.This requires adherence and supervision taking medication. There fore urgently needed education to improve adherence with the latest audiovisual and tutorial methods. The purpose of this research is to analyze the difference effectiveness of education based audiovisual and tutorial method on ARV treatment adherence with HIV/AIDS patients.Methods : This research use quasi experimental design with pretest and posttest without control group. The numbers of sample in this research is 27 sample. Responden group divided into three different education methode. 9 responden in audiovisual methode,9 responden in tutorial methode and 9 responden in audiovisual and tutorial methode. The study was conducted at the Clinic Teratai Hasan Sadikin Hospital in May-June, 2016. Results : There is a diference in average adherence. In audiovisual methode mean 2,444 (Pvalue=0,003, 95% CI=1,107-3,782), tutorial methode 1,556(Pvalue=0,023, 95% CI=1,274-2,837), audiovisual and tutorial methode mean 3,667 (Pvalue =0,003, 95% CI=1,670-5,664).Conclusion : There is a significant difference in the average adherence in difference methode.Especially in audiovisual and tutorial methode. The combination of audiovisual and tutorial-based education gives the best results

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