NepMed Repository :: Browsing by Author "Sah, BP"

Browsing by Author "Sah, BP"

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Analgesia after inguinal herniotomy in children: Combination of simplified (Single Puncture) ilioinguinal and iliohypogastric nerve blocks and wound infiltration vs. caudal block with 0.25% bupivacaine
(Kathmandu University, 2005) Bhattarai, BK; Rahman, TR; Sah, BP; Tuladhar, UR
Objective: To assess whether simplified ilioinguinal and iliohypogastric nerve block in combination with minimal wound infiltration with local anaesthetic is better than caudal block with local anaesthetic alone in children undergoing inguinal herniotomy for easy transition to safe oral analgesia. Subject and Methods: Sixty children of both sexes undergoing herniotomy were allocated randomly to receive either simplified (single puncture) ilioinguinal and iliohypogastric nerve block described by Dalens in combination with small volume wound infiltration with 0.1ml/kg of 0.25% bupivacaine (Group I) or caudal block with 1 ml/kg of 0.25% bupivacaine (Group II) at the end of surgery under general anaesthesia using halothane in oxygen and nitrous oxide mixture. Duration of analgesia, complication associated, parents and children’s satisfaction were compared. Results: The mean duration of analgesia was 253±102.6 minutes in group I as compared to 219.6±48.4 minutes in group II. Six (20%) patients in group I and two (6.67%) patients in group II required parenteral analgesic. Complications and parents and children’s satisfaction were comparable in both the groups. Conclusion: Simplified ilioinguinal and iliohypogastric nerve blocks described by Dalens in combination with small volume local anaesthetic wound infiltration with its longer mean duration of analgesia offers better safety margin to start oral analgesics than caudal block with local anaesthetic alone in children undergoing herniotomy. Larger studies may further confirm the findings. Key words: Simplified ilioinguinal and iliohypogastric nerve blocks, wound infiltration, caudal block
Analysis of Prognostic Factors of Bell’s Palsy in a Tertiary Care Centre of Eastern Nepal
(Kathmandu University, 2021) Paudel, D; Chettri, ST; Sah, BP; Dahal, R; Pyakurel, P
ABSTRACT Background Bell’s palsy is the most common cause of acute facial peripheral neuropathy commonly encountered in otolaryngology clinics. Studies regarding epidemiology, risk factors, treatment and prognosis of Bell’s palsy are sparse in our settings. Objective To analyze the prognostic factors of Bell’s palsy in tertiary care Centre of eastern Nepal. Method A retrospective chart review of patients diagnosed with Bell’s palsy from 1st January 2005 to 31st December 2018 was done. Records of the patients were obtained from medical record section of BP Koirala Institute of Health Sciences. Result A Total of 208 patients were included for analysis. After six months 72.6% patients had complete recovery. Patients who presented with lower House Brackmann (HB) grade had significantly better complete recovery than those with high grade (89.1% vs 45.6%). The complete recovery was 80.3%, 73.8%, 63.5% and 50% for the patients of more than 30 yrs, 31-45 years, 46-60 years and more than 60 years respectively and the difference was significant (p= 0.012). Alcohol significantly reduced the complete recovery (p= 0.043). Multivariate analysis showed high HB grade score at presentation to be significant predictor of poor prognosis. (p= 0.001 odds ratio 11.262). Conclusion Old age, use of alcohol and the severity of facial nerve palsy at the time of presentation were the bad prognostic factors, severity of the palsy was found to be most significant predictor. KEY WORDS Bad prognostic factors, Bell’s palsy, House brackmann grade
Effectiveness of addition of neostigmine or dexamethasone to local anaesthetic in providing perioperative analgesia for brachial plexus block: A prospective, randomized, double blinded, controlled study
(Kathmandu University, 2008) Yadav, RK; Sah, BP; Kumar, P; Singh, SN
Abstract Background: Various local anaesthetic agents are used for brachial plexus block.We compared effectiveness of addition of Dexamethasone versus Neostigmine to Lignocaine, adrenaline admixtures for Brachial plexus block in providing perioperative analgesia. Methods: Ninety patients were randomized in three groups and were received 24ml of study drugs. The groupA [Lignocaine with adrenaline (1.5%)], groupB [Lignocaine with adrenaline (1.5%)] +500μg Neostigmine, and group C (Lignocaine with adrenaline (1.5%) +4mg Dexamethasone) for brachial plexus block through supraclavicular approach. The observed parameters were onset of analgesia, completion of sensory and motor blockade, Duration of analgesia, Surgeon’s score, side effects, number of supplemental analgesics doses and Visual analogue scale (VAS) score for pain in 12 hour of post-operative period. Results: Mean onset of analgesia 4.6±1.1 , 4.4 ±0.8 , 3.8±1.8 mins in group A,B and C respectively and the Mean onset of motor blockade were 7.7± 2.0, 7.0±1.8, 6.0 ± 2.1mins in group A,B and C respectively. Similarly Mean Complete sensory block in 10.6 ±3, 10.4±2.5, and 8.9±2.2mins and Mean complete motor block in 17.3±4.3, 17.2 ±4.0 and 14.7±3.5 mins in group A, B and C respectively were achieved. Duration of analgesia was 176.5±53.5, 225.7±53.3 and 454.2±110.7 mins in group A, B and C respectively. Duration of analgesia in group C was statistically signi cant in comparison with other groups. The number of mean analgesic requirement by group C (0.9±0.4) was signi cantly (p- 0.005) lower. The mean VAS was signi cantly lower in groupC in 12 hours post-operatively. Conclusion: The onsets of action, duration of analgesia were better in dexamethasone group and also need less number of rescue analgesics requirement.
Outcomes of Microvascular Free Flap Reconstruction after Major Head and Neck Ablative Surgery at a Tertiary Teaching Hospital in Eastern Nepal
(Kathmandu University, 2023) Sah, BP; Paudel, D; Sarraf, DP
ABSTRACT Background Reconstruction with free flaps has significantly changed the outcome of patients with head and neck cancer. Microsurgery is still considered a specialized procedure and is not routinely performed in the resource-constrained environment of developing country like Nepal. Objective To evaluate the clinical outcomes in patients who underwent different microvascular free flap reconstructions of head and neck defects after major ablative surgery. Method A retrospective study was conducted to review and analyze the data of patients with head and neck cancer who underwent microvascular free flap reconstruction after major ablative surgery from November 2017 to April 2021. The descriptive statistics were calculated using Microsoft Excel 2010. Result Out of 207 patients, 129 (62.32%) were males. Mean age was of 55.17±13.44 years. About 133 (64.25%) tumors were on gingivobuccal complex. Anterolateral thigh flap was the most common flap 112, (54.11%) used for the reconstruction. Facial artery was used in 174 (84.06%) patients for anastomosis. The overall success rate was 97.5%. Re-exploration was done in 22 (10.63%) cases out of which 11 (50%) cases were having flap compromise. Delayed flap failure occurred in 5 cases (2.5%) and salvage surgery was done with pectoralis major myocutanuos flap with a salvage rate of 54%. Minor complications were observed in 39 cases (18.84%) out of which donor site graft loss was observed in 19 (9.18%) patients. Conclusion In spite of advanced set up, with trained dedicated manpower the microvascular free flap reconstruction of head and neck defects is safe with high success rate even in resource constrained country like Nepal. KEY WORDS Free flap, Head and neck cancer, Microsurgery, Reconstruction

Browsing by Author "Sah, BP"

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