POST OPERATIVE ANALGESIA FOLLOWING OPEN CHOLECYSTECTOMY

Introduction: Pain following surgery is a universal phenomenon; it is often underestimated and undertreated. Epidural analgesia is considered to be the best method of pain relief after subcostal cholecystectomy. Epidural is effective technique that offers comparable analgesia and better side effect profile. Design: Quasi Experimental study. Period: Jan2010 to June 2010. Setting: Military Hospital Rawalpindi. Material and methods: This is a prospective, randomized control trial. The main objective of this study was to compare the number of rescue doses for postperative pain relief, after subcostal cholecystectomy under epidural anesthesia, in patients receiving continuous epidural infusion of bupivacain 0.125% with those receiving intermittent boluses. Thoracic epidural catheter was placed for post operative pain relief. Patients were divided into two equal groups. Patient receiving continuous epidural anaesthesia were placed in group A and those receiving intermittent doses were included in group B. Sampling technique: Purposive (non probability) sampling. Result: Patient who received intermittent boluses (group B) required less rescue doses of nalbuphine as compared to the patients who received continuous infusion of 0.125 bupivacain. Conclusions: Intermittent boluses of 0.125% bupivacain are considered a better method of postoperative pain relief than continuous infusion of 0.125 % bupivacain.

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ACUTE RENAL COLIC

The Professional Medical Journal ◽

10.29309/tpmj/2010.17.01.1982 ◽

2010 ◽

Vol 17 (01) ◽

pp. 59-63

Author(s):

MUHAMMAD ALI NAQVI ◽

Zl MIRZA

Keyword(s):

Emergency Department ◽

Side Effects ◽

Pain Relief ◽

Diclofenac Sodium ◽

Military Hospital ◽

Rescue Analgesia ◽

Quasi Experimental ◽

Group A ◽

Ureteric Colic ◽

Group B

Objective: To compare the efficacy of Nelbuphine hydrochloride (opioid) and Diclofenac Sodium (NSAID) in management of Acuterenal pain. Design: Prospective non-randomized quasi experimental study. Setting: This study was conducted in Emergency department (ED)of Combined Military Hospital, Lahore. Period: From 1st April 2008 to 31 July 2009. Patients and Method: A Total of 100 patients presentingin emergency department with a clinical diagnosis of renal and Ureteric colic were studied. They were randomly divided in to equal andcomparable groups, Group A & B. Severity of pain was assessed using a Visual Analogue scale (VAS). Group A was treated with IntravenousNelbuphine 10mg and group B was given intramuscular Diclofenac Sodium 75mg. Assessment of Pain relief, both onset and complete responsewas assessed in both groups. In addition to the pain relief, side effects like Nausea, vomiting, respiratory depression, drowsiness and injectionsite pain were also assessed. Results: Nelbuphine was found significantly superior (p=0.05) to Diclofenac, both for time of onset of pain reliefand complete pain relief. Moreover less patients required rescue analgesia in Group A (p=0.05). Only one patient treated with Group A hadrespiratory depression which was statistically insignificant (p=0.05). There was a 3.5% increase in Nausea and vomiting in Nelbuphine treatedpatients. Conclusion: Nelbuphine is a safe and rapid acting Opioid with few side effects. It should be preferred over Diclofenac sodium intreatment of Acute Renal pain.

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MYRINGOTOMY FOR THE TREATMENT OF OTITIS MEDIA WITH EFFUSION; A COMPARISON IN THE OUTCOME WITH AND WITHOUT GROMMET INSERTION

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71isuppl-3.7920 ◽

2021 ◽

Vol 71 (Suppl-3) ◽

pp. S521-25

Author(s):

Sunarays Akhtar ◽

Uzma Gul ◽

Arfat Jawaid ◽

Khalid Azam ◽

Muhammad Sohail Babur Niazi ◽

...

Keyword(s):

Otitis Media ◽

Otitis Media With Effusion ◽

Military Hospital ◽

Quasi Experimental ◽

Group A ◽

Group B ◽

Conductive Hearing ◽

Case Basis ◽

Method Group

Objective: To compare the outcome of myringotomy with and without grommet insertion in the patients of otitis media with effusion in terms of improvement of hearing in a one-month follow-up. Study Design: Quasi experimental study. Place and Duration of Study: Pakistan Airforce Hospital Jacobabad and Combined Military Hospital Lahore Pakistan, from Jan to Dec 2020. Methodology: A total of 28 patients aged 4-12 years diagnosed to have conductive hearing loss due to otitis media with effusion not responding to medical treatment were included. Non probability convenience sampling was done. Children aged less than 4 years and above 12 years were not included in the study. They were randomly divided into two groups of 14 patients each using lottery method. Group A underwent myringotomy alone whereas group B underwent myringotomy with grommet insertion. Patients in both groups also underwent adenoidectomy on case-to-case basis. Both groups were compared in terms of improvement in hearing post operatively in a one-month follow-up. Results: There was statistically significant reduction in air bone gap at the end of follow up period as compared to preoperative air bone gap in group B (p=0.007). In group A there was statistically significant reduction in air bone gap at one week (p=0.002) however this improvement was not maintained at 4 weeks (p=0.386). Conclusion: Myringotomy with grommet insertion had significantly more patients with improved hearing as compared to myringotomy alone after one month.

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COMPARISON OF THE EFFICACY OF ANTIBIOTIC-STEROID AND ICHTHAMMOL GLYCERINE WICK IN TREATMENT OF ACUTE OTITIS EXTERNA

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71isuppl-3.4556 ◽

2021 ◽

Vol 71 (Suppl-3) ◽

pp. S612-16

Author(s):

Maryam Khan ◽

Kamran Ashfaq Ahmed Butt ◽

Naeem Riaz ◽

Zaheer Ul Hassan ◽

Attique Ahmed ◽

...

Keyword(s):

Experimental Study ◽

Otitis Externa ◽

The Other ◽

Military Hospital ◽

P Value ◽

Similar Response ◽

Quasi Experimental ◽

Group A ◽

Group B

Objective: To compare the efficacy of steroid antibiotic wick with Ichthammol Glycerol wick in the management of Acute Otitis Externa in terms of tenderness and clearance of discharge/debris. Study Design: Quasi-experimental study. Place and Duration of Study: ENT Out Patient department of Combined Military Hospital Peshawar and Hayatabad Medical Complex Peshawar, from May to Nov 2018. Methodology: A total of 250 patients were included and divided into two groups of 125 each. After necessary suction clearance topical Ciprofloxacin/Dexamethasone (Cipotec-D) wick was placed in auditory canal of group A patients and topical Glycerol/Ichthammol wick was placed in group B. Follow up visits were done on 3rd and 7th day of starting the treatment. Results: Group A patients responded better in terms of tenderness (88%) however both groups had similar response in terms of discharge reduction (7.2% vs 6.4%). In terms of efficacy neither of the treatment proved more efficacious compared to the other (p-value 0.058). Conclusion: While steroid antibiotic wick is significantly more efficient in terms reducing tenderness, in terms of overall efficacy and discharge reduction Ichthammol/glycerol is equally effective.

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COMPARISON OF MICRODEBRIDER - ASSISTED TURBINOPLASTY VERSUS ENDOSCOPIC PARTIAL TURBINECTOMY IN CASES OF INFERIOR TURBINATE HYPERTROPHY IN ALLERGIC RHINITIS PATIENTS

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71isuppl-3.4121 ◽

2021 ◽

Vol 71 (Suppl-3) ◽

pp. S598-602

Author(s):

Muhammad Ahmed Khan ◽

Faiz Ul Hassan Nawaz ◽

Muhammad Tahir ◽

Hina Mazhar ◽

Muhammad Dawood ◽

...

Keyword(s):

Allergic Rhinitis ◽

Nasal Obstruction ◽

Inferior Turbinate ◽

Military Hospital ◽

Turbinate Hypertrophy ◽

Quasi Experimental ◽

Group A ◽

Group B ◽

Inferior Turbinate Hypertrophy ◽

Age Range

Objective: To compare microdebrider-assisted turbinoplasty versus endoscopic partial turbinectomy in cases of inferior turbinate hypertrophy in allergic rhinitis patients in terms of relief/improvement of nasal obstruction, post operative bleeding, crusting and synechie formation. Study Design: Quasi experimental study. Place and Duration of Study: Combined Military Hospital Mardan and Combined Military Hospital Malir, from Jan 2019 to Jan 2020. Methodology: A total of 90 patients of allergic rhinitis with severe nasal obstruction due to bilateral inferior turbinate hypertrophy fulfilling the inclusion exclusion criteria were selected. Cases were randomly divided into two groups of 45 each. Group A cases underwent microdebrider assisted turbinoplasty and Group B cases underwent partial turbinectomy via endoscpic approach. They were comparedin terms of post op bleeding, relief of nasal obstruction, post op crusting & synechie/adhesions. All the data was entered on SPSS-17 and analyzed. Results: Out of 90 cases, there were 43 (47.8%) females and 47 (52.2%) males with age range from 15-65, mean age 37.68 ± 11.56 Years. There was only 1 case of post op bleeding after microdebrider assisted turbinoplasty requiring nasal packing in contrast to 6 cases of post op bleeding after endoscopic partial turbinectomy. On one month post op visit, there was no case of nasal crusting in turbinoplasty group in contrast to 7 of mild and 1 of moderate crusting & 3 synechie/adhesions in endoscopic partial turbinectomy group. Conclusion: Microdebrider-assisted turbinoplasty is associated with less post operative bleeding and synechie formation as compared to endoscopic turbinectomy.

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Comparison of 4% Topical Hydroquinone versus Combination of Oral Tranexamic Acid and 4% Topical Hydroquinone in the Treatment of Epidermal Melasma

10.53350/pjmhs2115103406 ◽

2021 ◽

Vol 15 (10) ◽

pp. 3406-3409

Author(s):

Sarah Riaz ◽

Najia Ahmed ◽

Ayesha Anwar ◽

Moizza Tahir ◽

Farrah Yousaf ◽

...

Keyword(s):

Tranexamic Acid ◽

Topical Therapy ◽

Military Hospital ◽

Ethical Review ◽

P Value ◽

Treatment Groups ◽

Quasi Experimental ◽

Group A ◽

Group B ◽

Better Than

Objective: comparison of efficacy of topical 4% hydroquinone monotherapy with combination of oral tranexamic acid and topical 4% hydroquinone in the treatment of epidermal melasma Study design: Quasi experimental study Study period and place: Dermatology OPD, Pak Emirates Military Hospital Rawalpindi from July 2018 to January 2019. Methodology: Total 80 patients presenting with epidermal melasma were selected from outdoor patient department after applying the inclusion criteria and consent was taken from selected patients. Study was started after getting permission from hospital ethical review board. Two treatment groups were made after dividing patients by using alternate method. Treatment with topical 4% hydroquinone alone was started for group A patients and combination of capsule tranexamic acid (250 mg two times a day) along with topical 4% hydroquinone were started for group B patients for the next 6 months. Evaluation of patients through detailed history, clinical and wood’s light examination before starting therapy and after of 24 weeks of treatment was done for both groups. Efficacy of treatment was assessed via Modified MASI score. Results: Hydroquinone monotherapy was effective in 21 (52.5%) patients among group A while in group B patients, combination treatment i.e. oral tranexamic acid and topical hydroquinone, was effective in 31 (77.5%) patients (p value= 0.01). Conclusion: Effectiveness of Hydroquinone 4% topical therapy combined with oral tranexamic acid for epidermal melasma is better than topical 4% hydroquinone alone. Key words: Epidermal melasma, oral tranexamic acid, topical 4% hydroquinone.

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COMPARISON OF EFFICACY OF EPLEY MANOEUVRE AND VESTIBULAR SEDDATIVE IN POSITIONAL VERTIGO

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v1i1.7927 ◽

2021 ◽

Vol 71 (Suppl-3) ◽

pp. S437-39

Author(s):

Muhammad Sohail Babar Niazi ◽

Khawar Kamal ◽

Zaheer Ul Hassan ◽

Aisha Qaiser ◽

Shahid Farooq Khattak ◽

...

Keyword(s):

Benign Paroxysmal Positional Vertigo ◽

Military Hospital ◽

Chi Square ◽

Total Recovery ◽

Positional Vertigo ◽

Quasi Experimental ◽

Chi Square Test ◽

Group A ◽

Group B ◽

Paroxysmal Positional Vertigo

Objective: To carry out the comparison of the effectiveness of Epleys manoeuvre and Vestibular Sedative in the management of benign paroxysmal positional vertigo. Study Design: Quasi experimental study. Place and Duration of Study: Department of ENT, Combined Military Hospital Peshawar, from Jul 2019 to Dec 2020. Methodology: The study was conducted on 60 patients who were diagnosed Benign Paroxysmal Positional Vertigo by Dix Hallpike test. The patients were divided into 2 groups of 30 each. Group A was treated with vestibular sedative and group B was treated with Epleys manoeuvre. The examination of all patients was done on day 3, day 7 and day 14 and the results were documented. Results: The study revealed that the 30 cases which were managed by Epleys manoeuvre, 27 cases were completely symptom free after 14 days. Meanwhile from the 30 patients who were treated by oral vestibular sedation, only 5 patients had total recovery on 14th day. Chi square test was used to compare the results. The results showed that Epleys manoeuvre has greater efficacy in the treatment of Epleys man oeuvre than vestibular sedative. Conclusion: Epleys manoeuvre is more effective for the management of benign paroxysmal positional vertigo than vestibular sedative.

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COMPARISON OF ISOCONAZOLE NITRATE VERSUS NYSTATIN FOR TREATMENT OF OTOMYCOSIS

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v1i1.7949 ◽

2021 ◽

Vol 71 (Suppl-3) ◽

pp. S581-84

Author(s):

Muhammad Ahmed Khan ◽

Bushra Anwar ◽

Sumera Akram ◽

Attique Ahmed ◽

Sunarays Akhtar ◽

...

Keyword(s):

Marked Improvement ◽

External Auditory Meatus ◽

Military Hospital ◽

Moderate Improvement ◽

Quasi Experimental ◽

Group A ◽

Group B ◽

Age Range ◽

Minor Improvement ◽

Better Than

Objective: To compare isoconazole nitrate versus nystatin for treatment of otomycosis. Study Design: Quasi experimental study. Place and Duration of Study: Combined Military Hospital Bahawalpur and Combined Military Hospital Mardan, from Jan to Dec 2018. Methodology: Total 204 cases fulfilling the inclusion criteria were selected from outpatient department of Combined Military Hospital Bahawalpur and Mardan. They were divided into 2 groups of 102 each using random number tables. Group A cases were given Isocona-zole nitrate for application in external auditory meatus and group B cases were given Nystatin. All the cases were examined two weeks later and outcome was compared in terms of clinical improvement and symptoms resolution. Results: Out of 204, 125 patients were females and rest 79 were males. Age range was from 12-87 years with mean age 31 ± 2.4. Both groups were identical in terms of gender. In group A patients, 74 (72.5%) showed marked improvement after two week, 15 (14.7%) showed moderate improvement and 13 (12.7%) showed minor improvement. However, in group B, 55 (53.9%) showed marked improvement after two week, 23 (22.5%) showed moderate improvement and 24 (23.5%) showed minor improvement. Group A treatment was found significantly better than group B treatment (p=0.021). Conclusion: Isoconazole nitrate ointment was found significantly more effective for treating otomycosis than nystatin.

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A comparative study of efficacy of epidural versus interpleural bupivacaine for post operative analgesia after open cholecystectomy

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v9i4.10232 ◽

2014 ◽

Vol 9 (4) ◽

pp. 15-23

Author(s):

RK Yadav ◽

PC Majhi

Keyword(s):

Pain Relief ◽

Open Cholecystectomy ◽

Fixed Time ◽

Medical Sciences ◽

Time Intervals ◽

Thoracic Epidural ◽

Pain Scores ◽

Post Operative Pain ◽

Clinically Significant ◽

Made In

Background The conventional methods of administering the prescribed doses of intramuscular or intravenous analgesics at fixed time intervals results in widely fluctuating and inadequate plasma level leads to poor post operative pain relief. Despite all advances made in the field of medicine, this symptom called “Pain” has not been combated well. Objective The present study was carried out to compare the efficacy of epidural verses interpleural administration of bupivacaine(0.5%) with adrenaline for post operative pain relieve in patients undergoing open cholecystectomy. Methods We prospectively randomized and compared the post operative pain relieve with the reference of visual analog score (VAS) in patients undergoing elective open cholecystectomy in college of medical sciences-teaching hospital, Bharatpur, Chitwan. Forty adult patients undergoing elective cholecystectomy were divided into two groups. Twenty patients in each group were subjected to a different technique of post-operative analgesia, namely thoracic epidural and interpleural instillation of 0.5% bupivacaine. These two groups were then compared in relation to changes produced in the pain scores, vital parameters and complication and side effects associated with the two techniques. The study was conducted for 24 hour postoperatively. Observation: Both thoracic epidural and interpleural instillation of 0.5% bupivacaine compared favorably with regard to analgesia in the present study. In general, the pain relief following thoracic epidural was more complete compared to interpleural but this was not clinically significant. Conclusion The present study shows that both the techniques are equally effective in providing analgesia following cholecystectomy. However, neither technique rendered the patients completely pain free at all times during first 24 hours. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-4, 15-23 DOI: http://dx.doi.org/10.3126/jcmsn.v9i4.10232

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Effects of Aerobics Versus Core Stability Exercises for the Management of Primary Dysmenorrhea

10.53350/pjmhs211582442 ◽

2021 ◽

Vol 15 (8) ◽

pp. 2442-2444

Author(s):

Nighat Nasrullah Khan ◽

Saima Riaz ◽

Rehan Ramzan Khan ◽

Hira Mannan ◽

Sobia Ghafoor ◽

...

Keyword(s):

Rating Scale ◽

Sampling Technique ◽

Core Stability ◽

Primary Dysmenorrhea ◽

Menstrual Cycles ◽

Quasi Experimental ◽

Group A ◽

Numeric Pain Rating Scale ◽

Group B ◽

Pain Rating Scale

Objective: To compare the effects of aerobics and core stability exercises for the management of primary dysmenorrhea. Methodology: The study design was quasi-experimental, conducted in Yahya gym, Lahore, from February 2019 to July 2019. The sampling technique employed was non-probability convenient sampling with a sample size of 42 females within 18-30 years who had primary dysmenorrhea. The subjects were assigned into two groups. Group A was treated with aerobic exercises, while Group B was treated with core stability exercises with eight weeks workout plan and the results of three menstrual cycles were recorded. Stretching maneuvers were added as a standard treatment to both groups. Data were collected after 12 weeks and recorded for three menstrual cycles. Numeric Pain Rating Scale (NPRS) was used to measure pain intensity. Data were analyzed using IBM SPSS v.25. Results: Mean age of group A vs. group B participants was 25.23 ±2.64 vs. 21.38±3.41 years respectively. Mean BMI score of group A participants was 21.38±2.14 while for group B participants mean BMI score was 21.65±1.99 Kg/m2. Conclusion: This study concludes that both aerobic exercises and core stability exercises are effective to reduce the intensity of pain in primary dysmenorrhea. However aerobic exercises showed relatively better results in term of mean difference of NPRS score across both groups. Keywords: Menstruation, Primary dysmenorrhea, Exercise, Pain.

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COMPARISON OF LOCAL METHYLCOBALAMINE INJECTION VERSUS LOCAL BUPIVACAINE INJECTION FOR THE TREATMENT OF ACUTE HERPETIC NEURALGIA

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i6.6464 ◽

2022 ◽

Vol 71 (6) ◽

pp. 2228-2231

Author(s):

Ghazala Yasmin ◽

Naeem Raza ◽

Arfan -Ul- Bari ◽

Farah Yousaf ◽

Summaya Saleem ◽

...

Keyword(s):

Pain Score ◽

Subcutaneous Injection ◽

Visual Analogue Score ◽

Military Hospital ◽

Visual Analogue Pain ◽

Significant Difference ◽

Quasi Experimental ◽

Group A ◽

The Mean ◽

Group B

Objective: To compare the reduction in mean pain score with local Methylcobalamin injection versus local Bupivacaine injection in patients with acute herpetic neuralgia. Study Design: Quasi experimental study. Place and Duration of Study: Dermatology Outpatient Department, Pak Emirates Military Hospital, Rawalpindi, from Jun to Dec 2019. Methodology: Total 100 patients, having pain score more than 3, fulfilling the selection criteria were divided into two groups. Group A was treated with daily subcutaneous injection Bupivacaine, whereas Group B was treated with daily subcutaneous injection Methycobalamin at the site of neuralgia. Patients were followed up for 4 weeks. The pain score was noted. All the data was entered and analyzed on SPSS version 21. Results: In this study mean age of patients in group A was 43.82 ± 15.76 years and in group B was 44.76 ± 16.92 years. The mean visual analogue pain score at 4th week in the group A patients was 1.14 ± 0.32 and in group B was 1.90 ± 0.97. Statistically significant difference was found in group A (local Bupivacaine) with visual analogue score (VAS) at 4th week (pvalue=0.002). Conclusion: The local Bupivacaine injection showed significant reduction in mean pain score than local Methylcobalamin injection in patients with acute herpetic neuralgia.

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