Prevention of Succinylcholine Induced Postoperative Myalgia by Pretreatment with Lignocaine: A Randomized Controlled Study

Succinylcholine, a depolarizing muscle relaxant possesses a unique property of rapid onset and short duration of action, but is accompanied by side effects such as fasciculation and myalgia. The aim of this study was to investigate the prophylactic effect of intravenous lignocaine on the incidence and severity of succinylcholine-induced postoperative myalgia. This was a randomized controlled double blind study conducted at National Institute of ENT Dhaka, during September to December 2017. Eighty adult patients of American Society of Anesthesiologists status I and II of both sexes for elective surgery under general anesthesia were randomly allocated into two equal groups, lignocaine group and normal saline group. The patients of lignocaine group were pretreated with lignocaine 1.5 mg/kg body weight in 5 ml volume, while patients of normal saline group were given isotonic saline 0.9% in the same volume (5 ml) intravenously. Thereafter, anesthesia was induced in all patients, by injecting 1.5 mg/kg of fentanyl and 2 mg/kg of propofol intravenously. Following the loss of eyelid reflex, 1.5 mg/kg of succinylcholine was injected intravenously as a muscle relaxant and then the patients were intubated. The incidence and severity of myalgia were assessed by a blinded observer 24 hours after surgery. In terms of demographic data, the results of this study showed that there is no significant difference between patients in both groups (P>0.05). Overall, the incidence and severity of succinylcholine-induced myalgia in lignocaine group was significantly less, when compared with normal saline group (P<0.05). Pretreatment with intravenous lignocaine is effective in prevention of postoperative succinylcholine induced myalgia. Faridpur Med. Coll. J. Jan 2019;14(1): 13-15

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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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Effects of prophylactic ketamine and pethidine to control postanesthetic shivering: A comparative study

Biomedical Research and Therapy ◽

10.15419/bmrat.v5i12.508 ◽

2018 ◽

Vol 5 (12) ◽

pp. 2898-2903 ◽

Cited By ~ 1

Author(s):

Masoum Khoshfetrat ◽

Ali Rosom Jalali ◽

Gholamreza Komeili ◽

Aliakbar Keykha

Keyword(s):

Normal Saline ◽

Pearson Correlation ◽

Saline Group ◽

Normal Saline Group ◽

Chi Square ◽

Double Blind ◽

Postanesthetic Shivering ◽

Significant Difference ◽

The Mean ◽

One Way Anova

Background: Shivering is an undesirable complication following general anesthesia and spinal anesthesia, whose early control can reduce postoperative metabolic and respiratory complications. Therefore, this study aims to compare the effects of prophylactic injection of ketamine and pethidine on postoperative shivering. Methods: This double-blind clinical trial was performed on 105 patients with short-term orthopedic and ENT surgery. The patients were randomly divided into three groups; 20 minutes before the end of the surgery, 0.4 mg/kg of pethidine was injected to the first group, 0.5 mg/kg of ketamine was injected to the second group, and normal saline was injected to the third group. After the surgery, the tympanic membrane temperature was measured at 0, 10, 20, and 30 minutes. The shivering was also measured by a four-point grading from zero (no shivering) to four (severe shivering). Data were analyzed by one-way ANOVA, Kruskal Wallis, Chi-square and Pearson correlation. Results: The mean age of patients was 35.8+/-11.45 years in the ketamine group, 34.8+/-11.64 years in the normal saline group, and 33.11+/-10.5 years in the pethidine group. The one-way ANOVA showed no significant difference in the mean age between the three groups (P=0.645). The incidence and intensity of shivering were significantly higher in the normal saline group than in the ketamine and pethidine groups (p=0.001). However, there was no significant difference in the incidence and the intensity of shivering between the ketamine and the pethidine groups (p=0.936). Conclusion: The results showed that the 0.5 mg/kg of ketamine could control the post-anesthetic shivering.

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Daflon 500 mg: Symptoms and Edema

Angiology ◽

10.1177/00033197050560i105 ◽

2005 ◽

Vol 56 (6_suppl) ◽

pp. S25-S32 ◽

Cited By ~ 11

Author(s):

Albert-Adrien Ramelet

Keyword(s):

Quality Of Life ◽

Controlled Study ◽

Venous Disease ◽

Double Blind Study ◽

Life Questionnaire ◽

Double Blind ◽

Randomized Controlled ◽

Randomized Controlled Studies ◽

Significant Difference

Patients suffering from any class of the Clinical, Etiological, Anatomical, Pathophysiological (CEAP) classification of chronic venous disease (CVD) may be symptomatic (C0s-C6s). Leg heaviness, discomfort, itching, cramps, pain, paresthesia, and edema (C3) are the most frequent manifestations of CVD and a major reason for medical consultation. Daflon 500 mg (micronized purified flavonoid fraction [MPFF]) is an effective treatment for symptoms and edema in CVD as demonstrated in several randomized controlled studies. A 2-month, double-blind study in 40 patients established the superiority of Daflon 500 mg over placebo with regard to symptoms and objective signs. This was confirmed in another double-blind, placebo-controlled trial (2 months’ treatment, 160 patients), and in the Reflux assEssment and quaLity of lIfe improvEment with micronized Flavonoids (RELIEF) study. The latter included 5,052 patients in 23 countries, using a visual analog scale for evaluating pain, leg heaviness, cramps, and a sensation of swelling. All symptoms showed significant and progressive improvement. The quality-of-life results (scores on the ChronIc Venous Insufficiency quality of life Questionnaire [CIVIQ]) paralleled those of symptoms. The decrease in the ankle and calf circumferences was significantly greater (p<0.001) in the group of patients treated with Daflon 500 mg in two studies, and correlated well with the improvement in the sensation of swelling (p<0.001). This was confirmed with more sophisticated measurement techniques as in the RELIEF study or in a trial assessing edema with an optoelectronic volumeter in 20 patients. A further double-blind, randomized, controlled study established a statistically significant difference in favor of Daflon 500 mg in comparison with diosmin, both on symptoms and edema. The therapeutic efficacy of Daflon 500 mg on CVD symptoms and edema has been demonstrated in double-blind, randomized, controlled studies. Further studies using a new approach may define the most precise and validated methodology for application in future research in phlebology.

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The Influence of Adrenaline on Postoperative Analgesia after Subarachnoid Morphine

Anaesthesia and Intensive Care ◽

10.1177/0310057x9302100119 ◽

1993 ◽

Vol 21 (1) ◽

pp. 79-84 ◽

Cited By ~ 10

Author(s):

M. J. Paech

Keyword(s):

Side Effects ◽

Postoperative Analgesia ◽

Saline Group ◽

Control Group ◽

Double Blind Study ◽

Gynaecological Surgery ◽

Normal Saline Group ◽

Double Blind ◽

Significant Difference ◽

To Receive

A randomised, double-blind study was conducted to investigate the postoperative effects of subarachnoid morphine, with or without adrenaline, after major gynaecological surgery. Seventy-five women having spinal anaesthesia combined with either sedation or general anaesthesia were randomised to receive subarachnoid morphine 0.25 mg with (group MA) or without (group M) adrenaline 200 ūg; or normal saline (group C). Groups M (n=22) and MA (n=25) differed significantly from control (n=23) with respect to the quality and duration of postoperative analgesia (P<0.0002) and to a higher incidence of pruritus (P<0.02). Groups were similar with respect to the incidence of other postoperative side-effects and respiratory data, although the latter showed a trend to less hypoxaemia in the control group. There was no significant difference in any outcome between groups MA and M. It was concluded that, under the study conditions in a post-gynaecological surgery population, the addition of adrenaline to subarachnoid morphine was of no benefit.

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Heparinized saline versus normal saline for maintaining peripheral venous catheter patency in China: An open-label, randomized controlled study

Journal of International Medical Research ◽

10.1177/0300060516685203 ◽

2017 ◽

Vol 45 (2) ◽

pp. 471-480 ◽

Cited By ~ 3

Author(s):

Lichun Xu ◽

Yan Hu ◽

Xiaojin Huang ◽

Jianguo Fu ◽

Jinhui Zhang

Keyword(s):

Normal Saline ◽

Venous Catheter ◽

Saline Group ◽

Randomized Controlled Study ◽

Chinese Patients ◽

Controlled Study ◽

Tertiary Referral Hospital ◽

Open Label ◽

Peripheral Venous Catheter ◽

Randomized Controlled

Objective To evaluate the effects of heparin saline versus normal saline as locking solution for maintaining patency in peripheral venous catheters in Chinese patients. Methods This open-label, randomized controlled study was conducted in two hepatobiliary surgery wards, where patients received identical treatments, at a tertiary referral hospital. Patients were randomly divided into a normal saline group (NS, 3 ml) or a heparin saline group (HS, 50 IU/ml, 3 ml) for catheter sealing. Results The study enrolled 286 patients and 609 peripheral venous catheters were included in the analysis. The patients in the two groups had no local infections or catheter-related bloodstream infections. There were no significant differences between the two groups in terms of the rate of catheter obstruction, duration time, or the rates of phlebitis, infiltration, and accidental catheter removal. Conclusions No significant differences in the peripheral venous catheter sealing effects were observed between normal saline and heparin saline usage in Chinese patients.

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Nimodipine reduces delayed cerebral vasospasm after intracranial tumor surgery: a retrospective study

10.21203/rs.3.rs-32931/v2 ◽

2020 ◽

Author(s):

Ying Yu ◽

Yunqian Li ◽

Zheng Jin ◽

Fan Chen

Keyword(s):

Retrospective Study ◽

Normal Saline ◽

Saline Group ◽

Intracranial Tumor ◽

Tumor Surgery ◽

Normal Saline Group ◽

Mortality And Morbidity ◽

Delayed Cerebral Vasospasm ◽

Significant Difference

Abstract Background：Cerebral vasospasm (CVS) is a serious neurosurgical complication. This retrospective study was performed to analyze if nimodipine can improve prognosis and reduces ischemia secondary to delayed CVS after intracranial tumor surgery.Methods：Retrospective analysis of 94 patients with an anterior cranial fossa tumor and underwent intracranial tumor surgery was performed, with 42 cases treated with normal saline and 52 cases treated with nimodipine solution. Transcranial Doppler ultrasonography was used to measure velocity in the middle cerebral artery (MCA) and the distal extracranial internal carotid artery (eICA). An examination was conducted 1 day before surgery and 1, 3, 5, 7, and 14 days after surgery. Follow-up was performed using the Glasgow Outcome Scale (GOS) 3 months after discharge.Results：We showed that in the nimodipine group, CVS occurred in 13 (25%) patients who did not have CVS in the first three days after operation; nine patients had CVS between 4 and 7 days, and 4 had CVS between 8 and 14 days. In the normal saline group, nineteen (45%) patients had CVS, 3 presented with CVS within 3 days, 11 between 4-7 days and 5 between 8-14 days. A significant difference in the occurrence of CVS was observed between the two groups. Preoperative and postoperative the MCA velocities were compared, revealing a significant change in the normal saline group (P < 0.05) but not in the nimodipine group. Furthermore, significant differences in the outcome were observed between the two groups at the 3-month follow-up (P < 0.05).Conclusions：Nimodipine markedly improves prognosis and significantly reduces ischemia secondary to delayed CVS after intracranial tumor surgery, as well as the risks of mortality and morbidity.

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The Effect of Preparing Dialysis Machine Using Normal Saline-Heparin on the Dialysis Adequacy of Hemodialysis Patients: A Crossover, Two-Group, and Randomized Clinical Trial

Nephro-Urology Monthly ◽

10.5812/numonthly.112475 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Seyed Reza Borzou ◽

Hiva Azami ◽

Mahmood Gholyaf ◽

Leili Tapak ◽

Tayebeh Nazari Doust

Keyword(s):

Normal Saline ◽

Saline Group ◽

Hemodialysis Patients ◽

Normal Saline Group ◽

Heparin Group ◽

Dialysis Adequacy ◽

Significant Difference ◽

Before And After ◽

Stage Renal Disease ◽

Hemodialysis Machine

Background: Patients with end-stage renal disease (ESRD) need adequate dialysis. Thus, identification of the ways to enhance dialysis adequacy is very important. Objectives: The present study was conducted to examine the effect of preparing a dialysis machine using a normal saline heparin method on the dialysis adequacy of hemodialysis patients. Methods: This study was conducted in Hamadan in 2019. A total of 36 patients with hemodialysis were selected using convenience sampling who were assigned to the control and intervention groups. The hemodialysis machine was primed for one month using a routine method (control) and one month using a normal saline-heparin method (intervention). Urea reduction ratio (URR) and Kt/V indices were calculated at the beginning and end of each month in the intervention and control groups. Data were analyzed using paired and independent t-test. Results: In the normal saline-heparin group, KT/V showed a statistically significant difference before and after the treatment (P = 0.013), as well as an increase in the KT/V. The URR as the mean dialysis adequacy showed a statistically significant difference (P = 0.004) between the normal saline group and the normal saline-heparin group before and after the treatment. Moreover, URR in the normal saline-heparin group increased after the treatment. In the normal saline treatment group, KT/V and URR decreased after the treatment. In the normal saline group, URR decreased after the treatment. Conclusions: Applying the hemodialysis machine preparation with a normal saline-heparin method increased dialysis adequacy in the patients who underwent hemodialysis.

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1151. A Comparison of Periurethral Cleaning Between Normal Saline and Savlon Solutions Before Indwelling Urinary Catheterization in Reducing Catheter-Associated Bacteriuria: A Randomized Controlled Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1015 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S411-S411

Author(s):

Sarin Khahakaew ◽

Gompol Suwanpimolkul ◽

Thanittha Wongkeskij ◽

Napawan Punakabutra ◽

Chusana Suankratay

Keyword(s):

Emergency Room ◽

Normal Saline ◽

Foley Catheter ◽

Randomized Controlled Study ◽

Controlled Study ◽

Urinary Catheterization ◽

Antiseptic Solution ◽

Randomized Controlled ◽

Randomized Controlled Studies ◽

Significant Difference

Abstract Background Catheter-associated urinary tract infection (CAUTI) is one of the most common nosocomial infections. To date, there have been no randomized controlled studies to recommend the most appropriate antiseptic solution for periurethral cleaning before indwelling urinary catheterization. This study was aimed to compare normal saline solution (NSS) and Savlon solution for periurethral cleaning before indwelling urinary catheterization in reducing catheter-associated bacteriuria. Methods A randomized controlled, noninferiority, cross-over study to determine the incidence of significant bacteriuria (SB) on day 5 after Foley catheterization, using 2 different solutions for periurethral cleaning (NSS and Savlon solutions), was carried out in all adult patients admitted in the 2 medical intensive care units (ICUs), 1 surgical ICU, 2 neurosurgical ICUs, 4 medical wards, 4 surgical wards and 1 emergency room (ER) of King Chulalongkorn Memorial Hospital, Thailand, from June 2018 to March 2019. The acceptable prespecified noninferiority margin was set to be 10%. Each solution was used alternately every 3 months in each unit. Urine culture was collected on day 1, 3, and 5 of Foley catheter. Results During the study period, there were 207 and 160 patients in the NSS and Savlon groups, respectively. 202 (55%) patients had received Foley catheterization in the emergency room. There were no significant differences in the indication, the current illness, and preexisting condition between the 2 groups. The overall incidence of SB on day 3 and 5 after catheterization was 4% and 8.2%. The incidence of CAUTI was 3.43/1,000 catheter-day. The median duration of catheterization was 5 (IQR 3, 7) days. On day 5 after catheterization, noninferiority was demonstrated for the incidence of SB with an adjusted difference of 4 (95% CI of the difference: −2.1% to 8.9%, P = 0.05). Regarding the incidence of CAUTI, there was no significant difference between the 2 groups. Conclusion To the best of our knowledge, our study was the first randomized controlled study to compare the 2 solutions for periurethral cleaning before indwelling urinary catheterization in different departments. This study demonstrates the noninferiority of NSS to Savlon solution in reducing the incidence of SB. Disclosures All authors: No reported disclosures.

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Nimodipine reduces delayed cerebral vasospasm after intracranial tumor surgery: a retrospective study

10.21203/rs.3.rs-32931/v3 ◽

2020 ◽

Author(s):

Ying Yu ◽

Yunqian Li ◽

Zheng Jin ◽

Shuai Zhao ◽

Fan Chen

Keyword(s):

Retrospective Study ◽

Cerebral Vasospasm ◽

Normal Saline ◽

Saline Group ◽

Intracranial Tumor ◽

Tumor Surgery ◽

Normal Saline Group ◽

Delayed Cerebral Vasospasm ◽

Significant Difference

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Randomized Controlled Trial and Meta-analysis of Oral Decontamination with 2% Chlorhexidine Solution for the Prevention of Ventilator-Associated Pneumonia

Infection Control and Hospital Epidemiology ◽

10.1086/526438 ◽

2008 ◽

Vol 29 (2) ◽

pp. 131-136 ◽

Cited By ~ 144

Author(s):

Hutsaya Tantipong ◽

Chantana Morkchareonpong ◽

Songyod Jaiyindee ◽

Visanu Thamlikitkul

Keyword(s):

Randomized Controlled Trial ◽

Normal Saline ◽

Controlled Trial ◽

Meta Analysis ◽

Saline Group ◽

Ventilator Associated Pneumonia ◽

Normal Saline Group ◽

Randomized Controlled ◽

Oral Decontamination ◽

Chlorhexidine Solution

Objective.To determine the effectiveness of oral decontamination with 2% chlorhexidine solution for the prevention of ventilator-associated pneumonia (VAP).Design.Randomized controlled trial and meta-analysis.Setting.A tertiary care university hospital in Bangkok, Thailand.Participants.Adult patients who received mechanical ventilation and who were hospitalized in intensive care units and general medical wards.Methods.The patients were randomized to receive oral decontamination with 2% chlorhexidine solution or normal saline solution 4 times per day until their endotracheal tubes were removed. The outcome measures were the development of VAP and oropharyngeal colonization with gram-negative bacilli. Meta-analysis was performed by combining the results of the present study with those from another randomized controlled trial that also used a 2% chlorhexidine formulation for oral decontamination.Results.The characteristics of the patients in the chlorhexidine group (n= 102) and the normal saline group (n= 105) were not significantly different. The incidence of VAP in the chlorhexidine group was 4.9% (5 of 102), and the incidence in the normal saline group was 11.4% (12 of 105) (P= .08). The rate of VAP in the chlorhexidine group was 7 episodes per 1,000 ventilator-days, and the rate in the normal saline group was 21 episodes per 1,000 ventilator-days (P= .04). Irritation of the oral mucosa was observed in 10 (9.8%) of the patients in the chlorhexidine group and in 1 (0.9%) of the patients in the normal saline group (P= .001). Oropharyngeal colonization with gram-negative bacilli was either reduced or delayed in the chlorhexidine group. Overall mortality of the patients did not differ significantly between the groups. Meta-analysis of 2 randomized controlled trials revealed an overall relative risk of VAP for patients in the chlorhexidine group of 0.53 (95% confidence interval, 0.31-0.90;P= .02).Conclusion.Oral decontamination with 2% chlorhexidine solution is an effective and safe method for preventing VAP in patients who receive mechanical ventilation.

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