A COMPARATIVE STUDY OF TWO DIFFERENT DOSES OF DEXMEDETOMIDINE AS ADJUNCT TO LIDOCAINE IN INTRAVENOUS REGIONAL ANESTHESIA

The aim: To compare the different doses of dexmedetomidine as adjuvant to lidocaine in intravenous regional anesthesia. Materials and methods: Ninety patients participated in this study in Al-Yarmook teaching hospital in period between January 1st 2016 – July 1st 2016, divided randomly in to 3 groups. Group 1: received lidocaine diluted with normal saline; Group 2 – lidocaine with dexmedetomidine 0.5 μg/kg; Group3 -lidocaine with dexmedetomidine 1 μg/kg. Statistical analysis was done by IBM SPSS program version 20 and Microsoft excel version 2010 , the means were compared by ANOVA methods and Dunnett t3, significancebetween groups were recorded if p value less than 0.05. Results: Dexmedetomidine was effective in decreasing the sensory block onset time and motor block onset time and prolongation of the motor and sensory recovery with no significant hemodynamic changes than is often shown by the lidocaine alone, it also prolongs the time interval for analgesic requirement after the operation. For the group 3 it was faster than in group 2 and faster than in group 1 significantly (p value < 0.001) to form a sensory block onset and motor block onset; and it took significantly more time to recover the sensation than in group 1 (p value <0.001) and 2 (p value <0.002) , and more time for motor recovery than in group 1 (p value < 0.001). Group 3 had the longest time to call for the analgesia after operation than group 2 and 3 (p value < 0.001); and group 2 also had longer time for the same process than group 1 (p value < 0.001). Conclusions: A variety of adjuvants have been used in IVRA to decrease tourniquet pain, improve block quality, and prolong analgesia after cuff deflation. Opioids are relatively ineffective and cause nausea, vomiting, and dizziness after tourniquet deflation, but several NSAIDs have been shown to be beneficial, dexmedetomidine improves block quality and postoperative analgesia.

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No Enhancement of Sensory and Motor Blockade by Neostigmine Added to Mepivacaine Axillary Plexus Block

Anesthesiology ◽

10.1097/00000542-199907000-00014 ◽

1999 ◽

Vol 91 (1) ◽

pp. 78-83 ◽

Cited By ~ 42

Author(s):

Herve Bouaziz ◽

Xavier Paqueron ◽

Marie Lorraine Bur ◽

Michel Merle ◽

Marie Claire Laxenaire ◽

...

Keyword(s):

Side Effects ◽

Postoperative Analgesia ◽

Motor Block ◽

Saline Solution ◽

Hand Surgery ◽

Sensory Block ◽

Group 3 ◽

Group 2 ◽

Plexus Block ◽

Group 1

Background Intrathecal neostigmine induces analgesia but also several side effects. Recently, 500 microg neostigmine administered intraarticularly was shown to produce postoperative analgesia without side effects. The authors' goal was to determine whether 500 microg neostigmine added to mepivacaine in axillary plexus block prolongs postoperative analgesia. In addition, they wanted to determine the incidence of side effects in patients undergoing hand surgery. Methods Sixty-nine outpatients scheduled for carpal tunnel syndrome repair with axillary plexus block were randomly assigned to one of three groups that received saline solution in the axillary plexus and subcutaneously (group 1), 500 microg neostigmine in the axillary plexus and saline solution subcutaneously (group 2), or saline solution in the axillary plexus and 500 microg neostigmine subcutaneously (group 3). Sensory and motor block in the four hand nerve distributions were assessed every 5 min for 30 min The duration of the sensory and motor blocks were assessed after operation. Side effects were also recorded. Results Neostigmine had no effect on sensory and motor block in any of the four nerve distributions, nor did it increase the median duration of sensory block (215 min; range, 120-330 min) compared with group 1 (247 min; range, 190-287 min) or group 3 (236 min; range, 160-280 min). Motor block was slightly shorter (P = 0.045) in group 3 (190 min; range, 135-285 min) compared with group 1 (218 min; range, 145257 min) and group 2 (215 min; range, 105-343 min). Gastrointestinal side effects occurred in 30% of patients in both neostigmine groups but not in group 1 (P < 0.05). Conclusions This study suggests that 500 microg neostigmine added to mepivacaine in axillary plexus block does not prolong postoperative sensory block, but it does cause a relatively high incidence of side effects. These two findings raise doubts about the use of neostigmine associated with local anesthetics for plexus neural block.

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DEXMEDETOMIDINE VS DEXAMETHASONE AS AN ADJUVANT TO 0.5% ROPIVACAINE IN ULTRASOUND GUIDED SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

10.36106/4035779 ◽

2021 ◽

pp. 25-28

Author(s):

Rahul Kumar ◽

Anant Prakash ◽

Chandeshwar Choudhary ◽

Debarshi Jana

Keyword(s):

Brachial Plexus ◽

Motor Block ◽

Controlled Trial ◽

Onset Time ◽

Ultrasound Guided ◽

Analgesic Consumption ◽

Upper Limb Surgery ◽

Group 3 ◽

Group 2 ◽

Group 1

Background And Aims: Both dexmedetomidine and dexamethasone have individually been shown to be benecial as an adjuvant to ropivacaine. We compared the efcacy of combination of ropivacaine with dexmedetomidine and ropivacaine with dexamethasone in ultrasound guided supraclavicular brachial plexus (SCBP) block. Material And Methods: In this prospective randomised double blind controlled trial, 60 ASA physical status I/II patients undergoing elective upper limb surgery under ultrasound guided SCBP block with 30 ml of 0.5% ropivacaine were randomised into three groups. Group 1 (n = 20) received 1 μg/kg of dexmedetomidine, and group 2 (n = 20) received 8 mg of dexamethasone in addition to ropivacaine, while group 3 (n = 20) received only ropivacaine. The primary outcomes studied were onset and duration of sensory and motor block. Secondary outcomes included duration of analgesia, total analgesic consumption in 24 h postoperatively and quality of block. ANOVA and Chi-square test were used to compare results on continuous measurements and categorical measurements, respectively. Results: Onset of sensory and motor block was faster in group 1 (13.5 ± 4.1 and 17.0 ± 4.1 min) and group 2 (15.6 ± 3.6 and 18.5 ± 3.7 min) as compared to group 3 (20.1 ± 5.3 and 24.9 ± 5.6 min; P < 0.001). Block duration was signicantly longer in group 1 and group 2 than in group 3. Duration of analgesia was prolonged in group 1 and 2 (1218.0 ± 224.6 and 1128.0 ± 207.5 min, respectively) as compared to group 3 (768.0 ± 273.7 min; P < 0.001). Twenty four hours analgesic consumption postoperatively was reduced in the two study groups. Conclusion: Both dexmedetomidine and dexamethasone when used as adjuvants to ropivacaine for SCBP block, block onset time, and prolong' block duration

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Development and Validation of the Questionnaire of Satisfaction with Perioperative Anesthetic Care for General and Regional Anesthesia in Taiwanese Patients

Anesthesiology ◽

10.1097/aln.0b013e318216e835 ◽

2011 ◽

Vol 114 (5) ◽

pp. 1064-1075 ◽

Cited By ~ 19

Author(s):

Wui-Chiu Mui ◽

Chia-Ming Chang ◽

Kong-Fah Cheng ◽

Tak-Yu Lee ◽

Kwok-On Ng ◽

...

Keyword(s):

Factor Analysis ◽

Patient Satisfaction ◽

Regional Anesthesia ◽

Anesthetic Care ◽

Anesthesia Group ◽

Confounding Variables ◽

Group 3 ◽

Group 2 ◽

Nomological Validity ◽

Group 1

Background To fulfill the increasing demand of service quality improvement in recent years, it is imperative to develop a proper instrument to evaluate patient satisfaction with perioperative anesthetic care for many institutes in Taiwan. Methods We used a six-factor 32-item pilot questionnaire developed in our previous study as our starting point in this study. Exploratory factor analysis of the pilot questionnaire for factor structure generation was performed in general anesthesia patients (group 1, n = 320) and resulted in the generation of the Patient Satisfaction with Perioperative Anesthetic Care questionnaire (PSPACq). Confirmatory factor analysis of the PSPACq in general anesthesia (group 2, n = 565) and regional anesthesia (group 3, n = 225) patients was performed for validation and cross-validation of the PSPACq model, respectively. The confounding variables and the patient loyalty effects on PSPACq scores were analyzed to evaluate the nomological validity of the PSPACq. Result Exploratory factor analysis of the pilot questionnaire in group 1 resulted in the development of the PSPACq (a seven-factor 30-item model). The standardized coefficients and indexes for the assessment of fit of the PSPACq model in group 2 (validation) and group 3 (cross-validation) patients revealed a well-fitting model. The results of the loyalty scores and confounding variables support the nomological validity of the PSPACq. Conclusions A valid and reliable questionnaire (PSPACq) with Taiwanese culture characteristics was developed and is suitable for testing of patient satisfaction with perioperative anesthesia care for patients receiving general or regional anesthesia for their surgery.

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Young people's lifestyle and frequency of physical activity – an original study

Pomeranian Journal of Life Sciences ◽

10.21164/pomjlifesci.681 ◽

2020 ◽

Vol 66 (4) ◽

pp. 54-60

Author(s):

Barbara Janota ◽

Elżbieta Szczepańska ◽

Karolina Janion

Keyword(s):

Physical Activity ◽

Positive Impact ◽

High Rate ◽

P Value ◽

Daily Consumption ◽

Unhealthy Lifestyle ◽

School Students ◽

Group 3 ◽

Group 2 ◽

Group 1

Abstract Introduction A healthy lifestyle, including healthy eating, frequent physical activity, abstention from recreational substances, appropriate amounts of sleep and restricted amounts of television and computer time have a positive impact on the development and health of adolescents. The aim of the study was to assess selected aspects of adolescent lifestyle with a focus on rates of physical activity. Materials and methods The study material included a questionnaire completed by 304 secondary school students. The answers were analysed with respect to the physical activity of the respondents and then grouped accordingly: group 1 consisted of respondents with a low rate of physical activity, group 2 with a moderate rate of physical activity and group 3 with a high rate of physical activity. Differences in the the percentages of healthy behaviour the groups engaged in was assessed using the Kruskal–Wallis ANOVA on ranks test. Post hoc, a 2-way test with Bonferroni correction was performed. A p value of <0.05 was considered statistically significant for all analyses. Results The recommended number of 4–5 meals a day is consumed mostly by individuals from group 2 (52.94%) and to the least extent by those in group 1 (47.17%). The recommended daily consumption of fruit is mostly reported by respondents from group 3 (39.34%) and the least, by those from group 1 (26.42%). Subjects from group 2 are least likely to drink alcohol, which is harmful for one's health (26.47%); this group also includes the largest number of individuals who do not smoke cigarettes (69.12%). The most favorable behaviour with regards to sleep is displayed by subjects from group 3, in which 10.38% of participants slept for the recommended 8–10 h a day. Conclusions The majority of adolescents, regardless of the frequency of physical activity they undertook, had an unhealthy lifestyle. The most favourable lifestyle was led by subjects who performed physical activity between once a week and a few times a month.

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Predictive Value of Minimal Residual Disease: Analysis By Flow-Cytometry in Children with Relapsed Acute Lymphoblastic Leukemia

Blood ◽

10.1182/blood.v126.23.2494.2494 ◽

2015 ◽

Vol 126 (23) ◽

pp. 2494-2494

Author(s):

Myriam Ruth Guitter ◽

Jorge Gabriel Rossi ◽

Elisa Sajaroff ◽

Carolina Carrara ◽

Pizzi Silvia ◽

...

Keyword(s):

Flow Cytometry ◽

Residual Disease ◽

Lymphoblastic Leukemia ◽

P Value ◽

Time Points ◽

Group 3 ◽

Group 2 ◽

To Receive ◽

Group 1

Abstract Introduction: Despite the advances observed in the outcome of pediatric acute lymphoblastic leukemia (ALL) treatment during the last 20 years, relapse remains the most common cause of treatment failure in childhood ALL. Several factors have been associated to the prognosis of these patients; however, minimal residual disease (MRD) emerges as a relevant predictor of outcome. Objectives: The aims of this study were to assess MRD by flow-cytometry in relapsed ALL and to evaluate its prognostic impact as a predictor factor of outcome at the end of the induction therapy and prior to hematopoietic stem cell transplantation (HSCT). Patients and Methods: From Aug'10 to Jun'15, 123 ALL patients were treated at our center. MRD determination at least at two time-points during relapse treatment was a requirement for considering a patient eligible for the present study. Sixty-six cases were excluded due to the following causes: 10 patients died during induction, 2 died early in complete remission (CR), 29 did not respond to chemotherapy, in 13 patients MRD determination was not performed: 4 did not have clinical data available, 4 patients were Down Syndrome and 4 children received treatment for relapse in other centers. Thus, fifty-seven patients achieved CR and were evaluated for MRD at two time points. Of them, 56 patients belonged to S4 and S3 and 1 patient to S1 group as defined by the Berlin-Frankfurt-Münster stratification for relapsed ALL. MRD was analyzed by multiparametric flow-cytometry following ALL-IC 2009 guidelines. Negative MRD was defined as disclosing less than 0.1% of blasts. For this analysis, patients were stratified based on MRD levels at two different time points: after end of induction, before HSCT or at any other time point during the follow-up for patients who did not undergo HSCT. Three groups were defined: Group-1: negative at both time points (n= 23), Group-2: positive at 1 time point (n= 13) and Group-3: positive at both time points (n= 21). Patients who relapsed before receiving HSCT were considered Group-3. Twenty-five patients underwent HSCT: 13 of them from Group-1, 9 from Group-2 (2 had positive MRD previous to receive HSCT) and 3 patients from Group-3. HSCT was performed with matched familiar donor in 16 cases and matched unrelated donor in 9 cases. Results: The distribution of events according to receiving or not HSCT was: 5 died due to transplant related mortality (TRM), 9 relapsed after receiving HSCT and 16 during treatment with chemotherapy. With a median follow-up of 16 (range: 6-67) months, overall 3-year EFS probability (EFSp) (SE) was 32 (8)%. The 3-year EFSp was 75 (11)% for Group-1, 24 (14)% for Group-2 and 0% for Group-3 (p-value <0.00001). Comparing patients who did not receive HSCT vs. patients who did, EFSp (SE) was 32 (12)% and 29 (11)% respectively (p-value: non-significant). The EFSp (SE) according to MRD groups in patients who underwent HSCT was: Group-1: 53 (19)%, Group-2: 14 (13)% and 0% for Group-3 (p-value: 0.06). Conclusions: MRD quantification by flow-cytometry demonstrated to be a significant prognostic factor for relapsed ALL. Both, TRM and death in CR rates, were high and should be decreased by improving supportive measures. MRD determination by flow-cytometry in patients who underwent HSCT showed a trend to achieve a better EFSp, thus representing a relevant tool for stratifying relapsed ALL patients in order to achieve a better selection of patients to receive HSCT. Disclosures No relevant conflicts of interest to declare.

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Effects of Clonidine as an Adjuvant to Lidocaine with Epinephrine in Ultrasound Guided Axillary Brachial Plexus Block: A Randomised Controlled Trial

Journal of Clinical Medicine ◽

10.3390/jcm10184181 ◽

2021 ◽

Vol 10 (18) ◽

pp. 4181

Author(s):

Anil Ranganath ◽

Tomas Hitka ◽

Gabriella Iohom

Keyword(s):

Brachial Plexus ◽

Normal Saline ◽

Motor Block ◽

Brachial Plexus Block ◽

Onset Time ◽

Ultrasound Guided ◽

Axillary Brachial Plexus Block ◽

Group 2 ◽

Plexus Block ◽

Group 1

This study evaluated the effects of adding adjuvant clonidine to lidocaine with epinephrine on the characteristics of ultrasound-guided axillary brachial plexus block (ABPB) for upper extremity surgery. Twenty-four patients were randomised to receive an ultrasound guided ABPB with 20 mL of lidocaine 2% with 1:200,000 epinephrine plus 2 mL of either normal saline 0.9% (Group 1) or a mixture of clonidine 1 µg/kg and normal saline 0.9% (Group 2). The outcome measures that were recorded were the overall onset time and the duration of sensory and motor block. The median (IQR) overall onset time of sensory and motor block was significantly shorter in Group 2 vs. Group 1 (5 (5–7.5) min vs. 10 (8.8–12.5) min; p < 0.001) and (5 (2.5–7.5) min vs. 7.5 (6.3–7.5) min; p = 0.001), respectively. The median (IQR) overall duration of sensory and motor block was significantly longer in Group 2 vs. Group 1 (225 (200–231) min vs. 168 (148–190) min; p < 0.001) and (225 (208–231) min vs. 168(148–186) min; p < 0.001), respectively. In ultrasound-guided ABPB, the addition of clonidine to lidocaine with epinephrine resulted in shorter onset time and prolonged duration of sensory and motor block.

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PREGNANCY INDUCED HYPERTENSION;

The Professional Medical Journal ◽

10.29309/tpmj/2014.21.03.2125 ◽

2014 ◽

Vol 21 (03) ◽

Author(s):

Asghar Khan ◽

Amin Fahim ◽

Aneela Qureshi ◽

Ghulam Shah Nizamani ◽

Mohammad Ahmed Azmi

Keyword(s):

University Hospital ◽

Control Group ◽

P Value ◽

Pregnancy Induced Hypertension ◽

Severity Of Disease ◽

Induced Hypertension ◽

Mild Preeclampsia ◽

Group 3 ◽

Group 2 ◽

Group 1

Objective: To assess the early detection of thrombocytopenia in womenpresenting with varying degree of pregnancy induced hypertension (PIH). Study Design: A casecontrol study. Place of Study: Hematology laboratory Isra University Hospital Hyderabad.Duration of Study: From July 2009 to December 2010. Materials and Methods: Total 130pregnant women were included in this study. The subjects were divided into three groups asGroup 1 with pre-eclampsia, Group 2 with eclampsia and Group 3 with normotensive pregnantwomen as control group. The Group 1 was further divided into two sub groups such as Subgroup1a with mild preeclampsia and Sub-group 2b with severe pre-eclampsia. Results:Anticoagulated whole blood samples (5cc) from all subjects were analyzed for the detection ofthrombocytopenia for the possible involvement of pregnancy induced hypertension. It was notedthat out of total subjects, 33(25.39%) had mild pre-eclampsia, 17(13.07%) had severe preeclampsia,15(11.54%) had eclampsia and 65 (50.0%) were normotensive pregnant women.Based on the comparative findings, the results showed significant differences between group 3and group 1a (p-value 0.001), group 3 and group 1b (p-value 0.001), group 2 and group 3 alsoshowed same results (p-value 0.001) but the subjects of group 1a and 1b when compared,showed non-significant findings (p value 0.955). Conclusion: The results suggested that earlydetection of platelet count provide significant role for the assessment of severity of disease inwomen with pregnancy induced hypertension when compared with normotensive pregnantwomen.

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Radiation-induced changes in the inflammatory microenvironment composition of lung cancer brain metastases.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.2528 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 2528-2528

Author(s):

Ariane Steindl ◽

Maximilian Mair ◽

Angelika Martina Starzer ◽

Karin Dieckmann ◽

Georg Widhalm ◽

...

Keyword(s):

Lung Cancer ◽

Radiation Therapy ◽

Brain Metastases ◽

T Cell Subsets ◽

P Value ◽

Inflammatory Microenvironment ◽

Significant Difference ◽

Group 3 ◽

Group 2 ◽

Group 1

2528 Background: Radiotherapy was postulated to impact the inflammatory microenvironment composition in patients with lung cancer brain metastases (BM). Methods: Formalin fixed and paraffin embedded BM specimens from treatment naïve patients (group 1) and from patients treated with radiation therapy including whole brain radiotherapy and/or stereotactic radiosurgery (group 2) or prophylactic cranial irradiation (group 3) before BM resection were identified from the Vienna Brain Metastasis Registry. T cell subsets (CD3+,CD8+,CD45RO+,FOXP3+,PD-L1+) were investigated using the Ventana Benchmark Ultra system Definiens software. Results: Specimens from 41 patients (28/41;68.3% NSCLC, 13/41;31.7% SCLC) were included in the study. A significant difference in CD3+TIL density between group 1 (median: 964.5cells/mm2) and group 2 (median: 283.4cells/mm2; p-value=0.021; Mann-Whitney-U test), as well as group 3 (median: 168.8 cells/mm2; p-value= 0.028; Mann-Whitney-U test) were observed. Furthermore, CD8+ and FOXP3+TIL densities of group 2 (CD8+ median: 172.1cells/mm2; FOXP3+ median: 210.7cells/mm2) were numerically lower compared to group 1 (CD8+ median: 190.1 cells/mm2; FOXP3+ median: 221.2 cells/mm2). Of 10/41 (24.4%) patients further resected BM tissue specimens after initial resection were available. Here, the inflammatory microenvironment of BM treated with radiation therapy between the resections was significantly associated with lower densities of CD3+ (median: 105.1 cells/mm2) and CD8+ (median: 20.3cells/mm2) compared to radiation-naïve patients (CD3+ median: 825.4cells/mm2; CD8+median: 105.5cells/mm2; p=0.037; Mann-Whitney U-test). Conclusions: Radiation treatment was associated with lower densities of TIL subsets in our BM cohort. Although results have to be interpreted with caution due to the limited sample size, further studies investigating the sequencing of radiotherapy and immune modulating therapies might be of interest. [Table: see text]

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COMPARISON OF THE ONSET OF SENSORY BLOCK USING LIDOCAINE 1.5% WITH ADRENALINE OR LIDOCAINE 1.5% WITH ADRENALINE AND DEXAMETHASONE IN ULTRASOUND GUIDED AXILLARY NERVE BLOCK FOR BELOW ELBOW SURGERIES

Wiadomości Lekarskie ◽

10.36740/wlek202109214 ◽

2021 ◽

Vol 74 (9) ◽

pp. 2337-2339

Author(s):

Nabaa Adnan Ahmed ◽

Alaa Hussein Altaei ◽

Mohammed Adel Jasim

Keyword(s):

Peripheral Nerve ◽

Nerve Block ◽

Peripheral Nerve Block ◽

Onset Time ◽

Sensory Block ◽

Axillary Nerve ◽

P Value ◽

Group A ◽

Group 2 ◽

Group B

The aim: To demonstrate the onset of dexamethasone when added to lidocaine in ultrasound regional axillary brachial block. Materials and methods: 30 patients participated in this study in Al-wasity hospital from June 1st to December 1st 2019; all were of ASA I-II type, aged 18-65 years old. All patients were scheduled for upper limb below elbow surgery with peripheral nerve block. They were divided randomly in to 2 groups: Group A: received 20 ml of lidocaine 1.5% with adrenaline 1:200000; Group 2 : received 20 ml of lidocaine with adrenaline and dexamethasone 8 mg. There was no significant differences among the groups regarding the change in pulse rate, MAP and Oxygen saturation. The group B was faster than group A (p value < 0.001) in both the time of cold sensory block onset and pinprick sensory block onset at all dermatome (C5,C6,C7,C8,T1). Results: A variety of adjuvants have been used with peripheral nerve block to decrease the onset time, improve block quality, and prolong analgesia. Steroids have been shown to be beneficial in improving block onset. Conclusions: Adding dexamethasone to lidocaine enhanced the onset time of the block with no hemodynamic effect.

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Efficacy and Safety of Different Doses of Vaginal Misoprostol Prior to Intra Uterine Contraceptive Device Insertion: A Randomized Double-Blind Clinical Trial

QJM ◽

10.1093/qjmed/hcab115.035 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Shaimaa G Helmy ◽

Mohammed A El-Kadi ◽

Mohamed E Elhodiby ◽

Mohamed H Salama

Keyword(s):

Controlled Trial ◽

Secondary Outcome ◽

Contraceptive Device ◽

Efficacy And Safety ◽

Double Blind ◽

Group 3 ◽

Group 2 ◽

Vaginal Misoprostol ◽

Different Doses ◽

Group 1

Abstract Objective This study aims to compare the efficacy and safety of different doses of vaginal misoprostol prior to IUCD insertion among women with nulliparous cervix “those who 29never delivered-vaginally”. Study design: The current study was a randomized, double-blind, placebo-controlled trial conducted in the Family Planning Clinic of Ain Shams University’s Maternity Hospital Egypt. It involved women who delivered only by elective CD (cesarean delivery). One hundred and eighty women were randomized into three groups, Group 1 received misoprostol 200 mcg. Group 2 received misoprostol 100 mcg. Group 3 received placebo. The primary outcome was pain scores which were measured using a visual analogue scale (VAS), the secondary outcome was the ease of insertion score (ES). Results VAS and ES were significantly lower in group 1 compared to group 2 and group 3 (P < 0.001).There was insignificant difference among the three groups as regards successful IUD insertion (P = 0.477). Duration of insertion was significantly lower in group 1 than group 2 (P < 0.001). Satisfaction was significantly higher in group 1 compared to group 2 and group 3 (P < 0.001) Conclusion The effect of misoprostol seems to be dose-dependent. Dose of 200mcg seems to be ideal with best efficacy and with no significant increase in the adverse effects Implications: The dose of 200mcg vaginal misoprostol prior to IUD insertion in women, who had never delivered vaginally before, seems to be the most effective dose. Trail to lower the dose to100mcg significantly compromises the efficacy without remarkable benefit on the side effect profile.

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