Pub Date : 2020-12-31DOI: 10.3126/MJPAHS.V3I2.35836
S. Timilsina, R. Shrestha, C. K. Shrestha, D. Kafle
Introduction: Hyperbaric Bupivacaine is the most widely used local anesthetic. A number of adjuvants have been used with local anesthetic agents in order to improve the quality and duration of analgesia and anesthesia. This study was carried out to assess the efficacy of intrathecal Tramadol as a spinal adjunct to prolong the duration of spinal anesthesia in lower abdominal surgeries. Materials and Methods: Sixty patients aged between 18 to 80 years, were randomly divided into two groups - Tramadol and Placebo group. Spinal anesthesia was given by using 25 Gauge Quinke spinal needle in sitting position with midline approach. Patients belonging to Tramadol group received 3 ml of 0.5% Bupivacaine along with 0.5 ml of Tramadol (25mg) and patients belonging to Placebo group received 3 ml of 0.5% Bupivacaine along with 0.5 ml of Normal Saline. In the postoperative ward, duration of analgesia was assessed by the time when first rescue analgesia was given. Visual Analogue Scale for pain was noted at the time of rescue analgesia. The total amount of opioid consumed over 24 hour postoperative period was noted. Hemodynamic like heart rate, systolic, diastolic and mean arterial blood pressures were also noted. Data were analyzed using independent t-test for continuous variables and chi-square test for categorical variables, p value <0.05 was considered significant. Results: The two groups were comparable with respect to age, weight, sex, ASA grading and duration of surgery. Mean duration of effective analgesia was 231.53 ± 22.00 min in Tramadol group and 125.40 ± 8.86 min in Placebo group (p = 0.001). The mean total amount of opioid consumption in 24 hours postoperative period was 145.00 ± 30.31 mg in Tramadol group and 171.67 ± 36.39 mg in Placebo group (p = 0.003). Mean of Heart rate, systolic, diastolic and mean arterial blood pressures were not significant between the two groups. Incidence of nausea and vomiting was statistically significant between the two groups with a p value of 0.010. Hypotension and bradycardia was statistically not significant between the two groups. Conclusion: Tramadol was effective adjuvant to hyperbaric bupivacaine for intrathecal use to increase the duration of spinal anesthesia in patients undergoing lower abdominal surgeries.
{"title":"Anelgesic Efficacy of Intra-Thecal Tramadol as a Spinal Adjunct to 0.5% Heavy Bupivacaine in Lower Abdominal Surgery","authors":"S. Timilsina, R. Shrestha, C. K. Shrestha, D. Kafle","doi":"10.3126/MJPAHS.V3I2.35836","DOIUrl":"https://doi.org/10.3126/MJPAHS.V3I2.35836","url":null,"abstract":"Introduction: Hyperbaric Bupivacaine is the most widely used local anesthetic. A number of adjuvants have been used with local anesthetic agents in order to improve the quality and duration of analgesia and anesthesia. This study was carried out to assess the efficacy of intrathecal Tramadol as a spinal adjunct to prolong the duration of spinal anesthesia in lower abdominal surgeries. \u0000Materials and Methods: Sixty patients aged between 18 to 80 years, were randomly divided into two groups - Tramadol and Placebo group. Spinal anesthesia was given by using 25 Gauge Quinke spinal needle in sitting position with midline approach. Patients belonging to Tramadol group received 3 ml of 0.5% Bupivacaine along with 0.5 ml of Tramadol (25mg) and patients belonging to Placebo group received 3 ml of 0.5% Bupivacaine along with 0.5 ml of Normal Saline. In the postoperative ward, duration of analgesia was assessed by the time when first rescue analgesia was given. Visual Analogue Scale for pain was noted at the time of rescue analgesia. The total amount of opioid consumed over 24 hour postoperative period was noted. Hemodynamic like heart rate, systolic, diastolic and mean arterial blood pressures were also noted. Data were analyzed using independent t-test for continuous variables and chi-square test for categorical variables, p value <0.05 was considered significant. \u0000Results: The two groups were comparable with respect to age, weight, sex, ASA grading and duration of surgery. Mean duration of effective analgesia was 231.53 ± 22.00 min in Tramadol group and 125.40 ± 8.86 min in Placebo group (p = 0.001). The mean total amount of opioid consumption in 24 hours postoperative period was 145.00 ± 30.31 mg in Tramadol group and 171.67 ± 36.39 mg in Placebo group (p = 0.003). Mean of Heart rate, systolic, diastolic and mean arterial blood pressures were not significant between the two groups. Incidence of nausea and vomiting was statistically significant between the two groups with a p value of 0.010. Hypotension and bradycardia was statistically not significant between the two groups. \u0000Conclusion: Tramadol was effective adjuvant to hyperbaric bupivacaine for intrathecal use to increase the duration of spinal anesthesia in patients undergoing lower abdominal surgeries.","PeriodicalId":256896,"journal":{"name":"Medical Journal of Pokhara Academy of Health Sciences","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132421814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-31DOI: 10.3126/MJPAHS.V3I2.35598
S. Shrestha, B. Shrestha, P. Ghimire
Introduction: Laparoscopic cholecystectomy is considered as the gold standard treatment for gallstone disease. There has remained a controversy on use of peri operative prophylactic antibiotics during laparoscopic cholecystectomy in reducing perioperative prophylaxis surgical site infections. Various studies has been done to evaluate whether single dose/ three doses or multiple doses are needed to decrease the incidence of surgical site infections. The objective of this study was to identify the incidence of postoperative surgical site infections with three doses of perioperative antibiotics after laparoscopic cholecystectomy. Materials and Methods: This is a retrospective observational study conducted at a private hospital from November 2017 to March 2020. All the patients received three doses of ceftriaxone 1 gram within the first 24 hours of surgery. The incidence of surgical site infection was noted. Results: A total of 449 patients who fulfilled the inclusion criteria were studied. The age ranged from 16 to 88 years. Male to female ratio was 1:4. Seven cases (1.55%) developed postoperative surgical site infections. Conclusion: Three doses of perioperative antibiotics are recommended in laparoscopic cholecystectomy to prevent postoperative surgical site infections.
{"title":"Antibiotic Prophylaxis in Laparoscopic Cholecystectomy: A Retrospective Study","authors":"S. Shrestha, B. Shrestha, P. Ghimire","doi":"10.3126/MJPAHS.V3I2.35598","DOIUrl":"https://doi.org/10.3126/MJPAHS.V3I2.35598","url":null,"abstract":"Introduction: Laparoscopic cholecystectomy is considered as the gold standard treatment for gallstone disease. There has remained a controversy on use of peri operative prophylactic antibiotics during laparoscopic cholecystectomy in reducing perioperative prophylaxis surgical site infections. Various studies has been done to evaluate whether single dose/ three doses or multiple doses are needed to decrease the incidence of surgical site infections. The objective of this study was to identify the incidence of postoperative surgical site infections with three doses of perioperative antibiotics after laparoscopic cholecystectomy. \u0000Materials and Methods: This is a retrospective observational study conducted at a private hospital from November 2017 to March 2020. All the patients received three doses of ceftriaxone 1 gram within the first 24 hours of surgery. The incidence of surgical site infection was noted. \u0000Results: A total of 449 patients who fulfilled the inclusion criteria were studied. The age ranged from 16 to 88 years. Male to female ratio was 1:4. Seven cases (1.55%) developed postoperative surgical site infections. \u0000Conclusion: Three doses of perioperative antibiotics are recommended in laparoscopic cholecystectomy to prevent postoperative surgical site infections.","PeriodicalId":256896,"journal":{"name":"Medical Journal of Pokhara Academy of Health Sciences","volume":"169 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121317276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-31DOI: 10.3126/MJPAHS.V2I2.28189
M. Baral
Background: The OCMC (One stop crisis management center) has been established in the recognized government hospitals of Nepal. The OCMC has built coalition and create an organizational management system with other organizations for providing comprehensive health and treatment services, legal aid services, and counseling services and make certain protection to the survivors of GBV (Gender based violence) as well as to manage and control GBV incident. Worldwide more than 119 countries have laws on domestic violence, 125 countries have laws on sexual pestering and 52 countries have laws on marital rape but still women are suffering from different physical, sexual and Psychological violence. Rape, hurt/battery, Indecent assault, are the main forms of violence. Materials and Methods: Study is conducted in Western regional Hospital Pokhara, in OCMC (One stop crisis management center). It is a cross-sectional type of study. Data collected by the observation, interview and case study from the survivors of violence, available published materials related to women Violence and OCMC are also studied. Total 200 cases of GBV survivors came to OCMC center of Kaski from 2073Baisakh to 2074Ashad and included in the study as a primary source of data. Conclusion and Result: Out of total 200 cases, sexual offence victims were maximum in number which was 140 and least were forced marriage victim which were only 4 in number. More than 50% of dalit caste people were the survivors of GBV cases. GBV cases were predominant in age group of 20- 30 years. Maximum numbers of victims of GBV in sexual offence cases were alleged Rape cases which accounts 85% of total cases came to OCMC center.
{"title":"Medico Legal Cases in One Stop Crisis Management Center (OCMC) Kaski","authors":"M. Baral","doi":"10.3126/MJPAHS.V2I2.28189","DOIUrl":"https://doi.org/10.3126/MJPAHS.V2I2.28189","url":null,"abstract":"Background: The OCMC (One stop crisis management center) has been established in the recognized government hospitals of Nepal. The OCMC has built coalition and create an organizational management system with other organizations for providing comprehensive health and treatment services, legal aid services, and counseling services and make certain protection to the survivors of GBV (Gender based violence) as well as to manage and control GBV incident. Worldwide more than 119 countries have laws on domestic violence, 125 countries have laws on sexual pestering and 52 countries have laws on marital rape but still women are suffering from different physical, sexual and Psychological violence. Rape, hurt/battery, Indecent assault, are the main forms of violence. \u0000Materials and Methods: Study is conducted in Western regional Hospital Pokhara, in OCMC (One stop crisis management center). It is a cross-sectional type of study. Data collected by the observation, interview and case study from the survivors of violence, available published materials related to women Violence and OCMC are also studied. Total 200 cases of GBV survivors came to OCMC center of Kaski from 2073Baisakh to 2074Ashad and included in the study as a primary source of data. \u0000Conclusion and Result: Out of total 200 cases, sexual offence victims were maximum in number which was 140 and least were forced marriage victim which were only 4 in number. More than 50% of dalit caste people were the survivors of GBV cases. GBV cases were predominant in age group of 20- 30 years. Maximum numbers of victims of GBV in sexual offence cases were alleged Rape cases which accounts 85% of total cases came to OCMC center.","PeriodicalId":256896,"journal":{"name":"Medical Journal of Pokhara Academy of Health Sciences","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128761115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-31DOI: 10.3126/MJPAHS.V2I2.28087
Madan Thapa, Shyam Sundar Parajuly, R. Adhikari, M. Shrestha
Objective: Anomaly scan at the second trimester provides the detail anatomical study of fetus. Any structural or morphological defects detected prenatally guides the parents and doctors for further counseling. The main objective of this study was to detect the fetal congenital anomalies in high risk patients at 18-22 weeks and highlight the effectiveness of prenatal ultrasound examination. Materials and Methods: This was a hospital based descriptive study done during the period of 2017 January to 2019 January in the department of Radiology, ultrasound unit, Pokhara Academy of Health Sciences, Nepal. Pregnant women who were first examined and evaluated by the Obstetrician during the ante-natal check up (ANC) either by asking the patient history or by mother age or any symptoms or chance of being abnormalities or high risk patients during that time frame (18-22 weeks) were enrolled for the study. Maternal age, parity, any history of previous anomalies, previous history of miscarriage/Intra Uterine Fetal Demise ( IUFD) or any exposure to radiation or drugs, history of other disease were recorded during the filling of consent form. High risk patients were identified by the Obstetrician and anomaly examination was prescribed at second trimester (18-20 weeks). Descriptive analysis was done using SPSS 20. Results: There were two hundred and twenty four patients who had undergone anomaly (targeted fetal anatomy) examination which were referred for “anomaly scan” from the gynaecology and obstetrics department during that period. Among all the cases, fourteen cases had anomalies detected during the scan (18-22 weeks). Out of which seven cases had central nervous system related anomalies, two cases had skeletal deformities (dysplasia), two case had urinary tract related anomalies, one had lungs related anomalies and one had single umbilical artery with polyhydroamnios associated with duodenal atresia and one case had malformation of lymphatic system ( cystic hygroma ) Conclusion: Our study revealed that ultrasound scan performed between 18-22 weeks of pregnancy is effective in diagnosing major fetal abnormalities in the high-risk patients.
{"title":"Effectiveness of Prenatal Ultrasound Examination at Second Trimester in Detecting Fetal Congenital Abnormalities-A Preliminary Study","authors":"Madan Thapa, Shyam Sundar Parajuly, R. Adhikari, M. Shrestha","doi":"10.3126/MJPAHS.V2I2.28087","DOIUrl":"https://doi.org/10.3126/MJPAHS.V2I2.28087","url":null,"abstract":"Objective: Anomaly scan at the second trimester provides the detail anatomical study of fetus. Any structural or morphological defects detected prenatally guides the parents and doctors for further counseling. The main objective of this study was to detect the fetal congenital anomalies in high risk patients at 18-22 weeks and highlight the effectiveness of prenatal ultrasound examination. \u0000Materials and Methods: This was a hospital based descriptive study done during the period of 2017 January to 2019 January in the department of Radiology, ultrasound unit, Pokhara Academy of Health Sciences, Nepal. Pregnant women who were first examined and evaluated by the Obstetrician during the ante-natal check up (ANC) either by asking the patient history or by mother age or any symptoms or chance of being abnormalities or high risk patients during that time frame (18-22 weeks) were enrolled for the study. Maternal age, parity, any history of previous anomalies, previous history of miscarriage/Intra Uterine Fetal Demise ( IUFD) or any exposure to radiation or drugs, history of other disease were recorded during the filling of consent form. High risk patients were identified by the Obstetrician and anomaly examination was prescribed at second trimester (18-20 weeks). Descriptive analysis was done using SPSS 20. \u0000Results: There were two hundred and twenty four patients who had undergone anomaly (targeted fetal anatomy) examination which were referred for “anomaly scan” from the gynaecology and obstetrics department during that period. Among all the cases, fourteen cases had anomalies detected during the scan (18-22 weeks). Out of which seven cases had central nervous system related anomalies, two cases had skeletal deformities (dysplasia), two case had urinary tract related anomalies, one had lungs related anomalies and one had single umbilical artery with polyhydroamnios associated with duodenal atresia and one case had malformation of lymphatic system ( cystic hygroma ) \u0000Conclusion: Our study revealed that ultrasound scan performed between 18-22 weeks of pregnancy is effective in diagnosing major fetal abnormalities in the high-risk patients.","PeriodicalId":256896,"journal":{"name":"Medical Journal of Pokhara Academy of Health Sciences","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129805568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-31DOI: 10.3126/MJPAHS.V2I2.28192
L. Vaidya, R. Sharma, Lumeshwor Acharya, N. Lamichhane, R. R. Timasina
Background: Opioid use is a serious global problem and the problem is increasing over years. Buprenorphine has been approved as a substitution therapy in Nepal, but there are few long-term studies of its effectiveness. Aim: This study aimed to assess the 1-year efficacy of buprenorphine and reasons for dropout. Materials and Methods: This study was conducted at Western Regional Hospital, Pokhara from 29th August 2016 to 31st August 2017. The Buprenorphine Maintenance Treatment Program (BMT) was started on 29th August 2016 and all the clients enrolled in the program within 1 year of starting BMT were included in the study. Results: 75% of the enrolled clients dropped out in 1-year period. Conclusion: Adherence to Buprenorphine was better in flexible dose adjustment group. Combination of buprenorphine and psychosocial treatment would have been related with better outcome.
{"title":"Adherence to Buprenorphine Maintenance Treatment Program in Western Nepal","authors":"L. Vaidya, R. Sharma, Lumeshwor Acharya, N. Lamichhane, R. R. Timasina","doi":"10.3126/MJPAHS.V2I2.28192","DOIUrl":"https://doi.org/10.3126/MJPAHS.V2I2.28192","url":null,"abstract":"Background: Opioid use is a serious global problem and the problem is increasing over years. Buprenorphine has been approved as a substitution therapy in Nepal, but there are few long-term studies of its effectiveness. \u0000Aim: This study aimed to assess the 1-year efficacy of buprenorphine and reasons for dropout. \u0000Materials and Methods: This study was conducted at Western Regional Hospital, Pokhara from 29th August 2016 to 31st August 2017. The Buprenorphine Maintenance Treatment Program (BMT) was started on 29th August 2016 and all the clients enrolled in the program within 1 year of starting BMT were included in the study. \u0000Results: 75% of the enrolled clients dropped out in 1-year period. \u0000Conclusion: Adherence to Buprenorphine was better in flexible dose adjustment group. Combination of buprenorphine and psychosocial treatment would have been related with better outcome.","PeriodicalId":256896,"journal":{"name":"Medical Journal of Pokhara Academy of Health Sciences","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121092421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-25DOI: 10.3126/mjpahs.v2i3.26111
G. Sharma, R. Adhikari, Shyam Sundar Parajuly, K. Adhikari
Introduction: Cervical cancer is one of the common cancers in women and is a major public health problem all over the world. It has significant contribution to high mortality and morbidity. Preinvasive lesions spontaneously regress to normal, remain stable for a long time or progress to higher degree of dysplasia followed by carcinoma cervix. Materials and Method This was a hospital based retrospective study where 456 patients’ records were reviewed. Pap smear was used as the screening tool for the detection of precancerous lesion among the women visiting Western Regional Hospital (WRH), Department of obstetrics and gynecology. Results: Among 456 patients screened, most of them were in the age group of 30-39 years (42.8%) and were of parity 3 (42.8%). Most of them had no risk factors for carcinoma cervix (54.4%). Early marriage accounted for the highest risk of developing precancerous lesion (32.7%). There were no carcinoma detected by Pap smear. The test was negative in 68.9%, Low-grade Squamous Intraepithelial Lesion (LSIL) was detected in 5.9% and 2.9% had High-grade Squamous Intraepithelial Lesion (HSIL). Pap smear was sent for screening purpose in asymptomatic women (37.1%) and among the symptomatic patients vaginal discharge was the most common indication of pap test (34.6%). Conclusion: A Pap smear is reliable, simple, non-invasive, cost effective, and easy screening tool for detection of precancerous lesions in a woman.
{"title":"Cervical Cancer screening in a tertiary care centre by Pap smear and its clinical correlation","authors":"G. Sharma, R. Adhikari, Shyam Sundar Parajuly, K. Adhikari","doi":"10.3126/mjpahs.v2i3.26111","DOIUrl":"https://doi.org/10.3126/mjpahs.v2i3.26111","url":null,"abstract":"Introduction: Cervical cancer is one of the common cancers in women and is a major public health problem all over the world. It has significant contribution to high mortality and morbidity. Preinvasive lesions spontaneously regress to normal, remain stable for a long time or progress to higher degree of dysplasia followed by carcinoma cervix. \u0000Materials and Method This was a hospital based retrospective study where 456 patients’ records were reviewed. Pap smear was used as the screening tool for the detection of precancerous lesion among the women visiting Western Regional Hospital (WRH), Department of obstetrics and gynecology. \u0000Results: Among 456 patients screened, most of them were in the age group of 30-39 years (42.8%) and were of parity 3 (42.8%). Most of them had no risk factors for carcinoma cervix (54.4%). Early marriage accounted for the highest risk of developing precancerous lesion (32.7%). There were no carcinoma detected by Pap smear. The test was negative in 68.9%, Low-grade Squamous Intraepithelial Lesion (LSIL) was detected in 5.9% and 2.9% had High-grade Squamous Intraepithelial Lesion (HSIL). Pap smear was sent for screening purpose in asymptomatic women (37.1%) and among the symptomatic patients vaginal discharge was the most common indication of pap test (34.6%). \u0000Conclusion: A Pap smear is reliable, simple, non-invasive, cost effective, and easy screening tool for detection of precancerous lesions in a woman. ","PeriodicalId":256896,"journal":{"name":"Medical Journal of Pokhara Academy of Health Sciences","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115340108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-25DOI: 10.3126/mjpahs.v2i3.26109
Rohini Sigdel, A. Shrestha, R. Amatya
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.
{"title":"Comparison of Ondansetron with Gabapentin for prevention of intrathecal morphine induced pruritus","authors":"Rohini Sigdel, A. Shrestha, R. Amatya","doi":"10.3126/mjpahs.v2i3.26109","DOIUrl":"https://doi.org/10.3126/mjpahs.v2i3.26109","url":null,"abstract":"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. \u0000Materials 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. \u0000Results: 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. \u0000Conclusion: 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.","PeriodicalId":256896,"journal":{"name":"Medical Journal of Pokhara Academy of Health Sciences","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115534160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-25DOI: 10.3126/mjpahs.v2i3.26113
Amrit Kc, Rahman Tanvir, A. Rafiqul, A. Hamid, Noor Towhida
Background: Though peritoneal dialysis has several limitations, it is still used in acute kidney injury (AKI) patients as an alternative method of Renal Replacement Therapy (RRT), especially in low socioeconomic countries. Materials and Method: This study included thirty patients diagnosed as AKI. Peritoneal access was established through flexible Tenckhoff catheter for Continuous Peritoneal Dialysis (CPD) and 6-8 exchanges were done in 24 hours. Results: Among 30 patients mean age was (mean±SD) 49.93±14.42 years. Seven (23.33%) patients were hemodynamically unstable. The cause of AKI was drug induced in 6(20.7%), hypovolemia/Acute Tubular Necrosis in 6(20.0%), sepsis in 5(16.7%), heart failure in 2(6.7%) and 11(36.7%) had multiple causes. In initial presentation, mean serum creatinine was 683.42 μmol/L, and the number of sessions required for stabilization of serum creatinine was 7.5±1.43, sessions required for correction of hyperkalemia and metabolic acidosis were 2.15±0.69 and 2.5±0.76 respectively. The delivered Kt/V urea was 1.95±0.14 weekly. Six (20.0%) patients had peritonitis, five (16.7%) had pericatheter leakage and four (13.33%) had catheter blockage. Among 30 patients, three patients (10%) had died, sixteen (59.3%) had recovery of renal function and rest did not recover renal function. Conclusion: CPD was effective for correction of metabolic and electrolyte imbalance.
{"title":"Outcome of Continuous Peritoneal Dialysis in Patient with Acute Kidney Injury","authors":"Amrit Kc, Rahman Tanvir, A. Rafiqul, A. Hamid, Noor Towhida","doi":"10.3126/mjpahs.v2i3.26113","DOIUrl":"https://doi.org/10.3126/mjpahs.v2i3.26113","url":null,"abstract":"Background: Though peritoneal dialysis has several limitations, it is still used in acute kidney injury (AKI) patients as an alternative method of Renal Replacement Therapy (RRT), especially in low socioeconomic countries. \u0000Materials and Method: This study included thirty patients diagnosed as AKI. Peritoneal access was established through flexible Tenckhoff catheter for Continuous Peritoneal Dialysis (CPD) and 6-8 exchanges were done in 24 hours. \u0000Results: Among 30 patients mean age was (mean±SD) 49.93±14.42 years. Seven (23.33%) patients were hemodynamically unstable. The cause of AKI was drug induced in 6(20.7%), hypovolemia/Acute Tubular Necrosis in 6(20.0%), sepsis in 5(16.7%), heart failure in 2(6.7%) and 11(36.7%) had multiple causes. In initial presentation, mean serum creatinine was 683.42 μmol/L, and the number of sessions required for stabilization of serum creatinine was 7.5±1.43, sessions required for correction of hyperkalemia and metabolic acidosis were 2.15±0.69 and 2.5±0.76 respectively. The delivered Kt/V urea was 1.95±0.14 weekly. Six (20.0%) patients had peritonitis, five (16.7%) had pericatheter leakage and four (13.33%) had catheter blockage. Among 30 patients, three patients (10%) had died, sixteen (59.3%) had recovery of renal function and rest did not recover renal function. \u0000Conclusion: CPD was effective for correction of metabolic and electrolyte imbalance. ","PeriodicalId":256896,"journal":{"name":"Medical Journal of Pokhara Academy of Health Sciences","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128876153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-25DOI: 10.3126/mjpahs.v2i3.26106
S. Poudel, N. Gurung, D. Adhikari, A. Acharya, S. Shrestha, A. Gurung, D. Shrestha, A. Poudel, B. Baral, Dilip Baral
Background: Inguinal herniorrhaphy is a common general surgical operation. The repair of recurrent hernia is difficult surgery due to obscured and distorted anatomy and risk of further recurrence. The aim of this study is to determine the outcome in terms of operative time, hospital stay, return to work, complications and recurrence of open pre-peritoneal repair for recurrent inguinal hernias after Lichtenstein tension-free hernioplasty. Materials and Method: It is a prospective observational study conducted at Western Regional Hospital, Pokhara from 2013 to 2016. A total of eight patients including referred from other centers were included. Pre-peritoneal repair was performed on recurrent hernias after Lichtenstein tension-free hernioplasty. Age, sex, operating time, hospital stay, time to return work, postoperative complications and recurrence of patients were noted. Statistical analysis was done using SPSS- 21. Patients were called for follow up in 2 weeks, 3 months and 12 months time. Results: Out of eight patients, seven were male, one was female with mean age of 59.5 years. Recurrence was common on direct inguinal hernia (six patients) who had previous Lichtenstein hernioplasty. Mean operative time was 43.13 minutes (35 to 50 minutes), mean hospital stay was 2.5 days (2 to 4 days) and mean time to return to work was 8.12 days (7 to 10 days). There was hematoma formation in one patient. Conclusion: Pre-peritoneal mesh repair is easy, safe, with less operative time, short hospital stay, low recurrence and complication rate for recurrent inguinal hernia after Lichtenstein hernioplasty.
{"title":"Pre-peritonial Repair for Recurrent Inguinal Hernia after Tension free Hernioplasty","authors":"S. Poudel, N. Gurung, D. Adhikari, A. Acharya, S. Shrestha, A. Gurung, D. Shrestha, A. Poudel, B. Baral, Dilip Baral","doi":"10.3126/mjpahs.v2i3.26106","DOIUrl":"https://doi.org/10.3126/mjpahs.v2i3.26106","url":null,"abstract":"Background: Inguinal herniorrhaphy is a common general surgical operation. The repair of recurrent hernia is difficult surgery due to obscured and distorted anatomy and risk of further recurrence. The aim of this study is to determine the outcome in terms of operative time, hospital stay, return to work, complications and recurrence of open pre-peritoneal repair for recurrent inguinal hernias after Lichtenstein tension-free hernioplasty. \u0000Materials and Method: It is a prospective observational study conducted at Western Regional Hospital, Pokhara from 2013 to 2016. A total of eight patients including referred from other centers were included. Pre-peritoneal repair was performed on recurrent hernias after Lichtenstein tension-free hernioplasty. Age, sex, operating time, hospital stay, time to return work, postoperative complications and recurrence of patients were noted. Statistical analysis was done using SPSS- 21. Patients were called for follow up in 2 weeks, 3 months and 12 months time. \u0000Results: Out of eight patients, seven were male, one was female with mean age of 59.5 years. Recurrence was common on direct inguinal hernia (six patients) who had previous Lichtenstein hernioplasty. Mean operative time was 43.13 minutes (35 to 50 minutes), mean hospital stay was 2.5 days (2 to 4 days) and mean time to return to work was 8.12 days (7 to 10 days). There was hematoma formation in one patient. \u0000Conclusion: Pre-peritoneal mesh repair is easy, safe, with less operative time, short hospital stay, low recurrence and complication rate for recurrent inguinal hernia after Lichtenstein hernioplasty. ","PeriodicalId":256896,"journal":{"name":"Medical Journal of Pokhara Academy of Health Sciences","volume":"147 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124695177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-25DOI: 10.3126/mjpahs.v2i3.26107
Bijaya Gautam, L. Banstola, Ritu Bashyal
Background: Lack of proper diet and use of different medications in heart failure contributes to electrolyte imbalance. Due to absence of routine measurement, their abnormalities are not recognized. This study is an attempt to portrait a picture of serum levels of electrolytes in heart failure patients Materials and Methods: 102 heart failure patients were enrolled in this study over 6 months period. Serum levels of magnesium, calcium, phosphorus, sodium and albumin were measured. SPSS ver. 20.0 was used to analyze the data. Analysis of Variance was used to find mean differences and Pearson’s correlation was used to establish the correlation. Results: Majority of patient fell under New York Heart Association (NYHA) class II and had isolated systolic heart failure. Mean serum values of sodium and magnesium were below the reference range. Mean values of serum sodium, magnesium and corrected calcium was less in patients receiving diuretics and digitalis. Likewise, serum phosphorus was more with diuretics and digitalis use. Also, serum sodium was less in Acetylcholine Eseterose (ACE) inhibitors use. Isolated diastolic heart failure patients had least serum calcium values. Although, serum sodium and magnesium value in heart failure patients was positively correlated, was not statistically significant. Conclusion: This study showed that low serum sodium and magnesium values are frequently associated in heart failure. Disturbances in other serum electrolytes could also be other cause of complications in heart failure which are not under routine investigation. Identification and correction of these disturbances could have significant impact. However, further studies are required to reinforce this idea.
{"title":"Serum Magnesium, Calcium and Phosphorus status in Heart Failure patients attending tertiary care center of Nepal","authors":"Bijaya Gautam, L. Banstola, Ritu Bashyal","doi":"10.3126/mjpahs.v2i3.26107","DOIUrl":"https://doi.org/10.3126/mjpahs.v2i3.26107","url":null,"abstract":"Background: Lack of proper diet and use of different medications in heart failure contributes to electrolyte imbalance. Due to absence of routine measurement, their abnormalities are not recognized. This study is an attempt to portrait a picture of serum levels of electrolytes in heart failure patients \u0000Materials and Methods: 102 heart failure patients were enrolled in this study over 6 months period. Serum levels of magnesium, calcium, phosphorus, sodium and albumin were measured. SPSS ver. 20.0 was used to analyze the data. Analysis of Variance was used to find mean differences and Pearson’s correlation was used to establish the correlation. \u0000Results: Majority of patient fell under New York Heart Association (NYHA) class II and had isolated systolic heart failure. Mean serum values of sodium and magnesium were below the reference range. Mean values of serum sodium, magnesium and corrected calcium was less in patients receiving diuretics and digitalis. Likewise, serum phosphorus was more with diuretics and digitalis use. Also, serum sodium was less in Acetylcholine Eseterose (ACE) inhibitors use. Isolated diastolic heart failure patients had least serum calcium values. Although, serum sodium and magnesium value in heart failure patients was positively correlated, was not statistically significant. \u0000Conclusion: This study showed that low serum sodium and magnesium values are frequently associated in heart failure. Disturbances in other serum electrolytes could also be other cause of complications in heart failure which are not under routine investigation. Identification and correction of these disturbances could have significant impact. However, further studies are required to reinforce this idea. ","PeriodicalId":256896,"journal":{"name":"Medical Journal of Pokhara Academy of Health Sciences","volume":"80 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116477475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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