Browsing by Author "Shah, SP"
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Publication The Analgesic Effectiveness of Ipsilateral Transversus Abdominis Plane Block in Adult Patients Undergoing Appendectomy: A Prospective Randomized Controlled Trial(Kathmandu University, 2015) Ghimire, A; Bhattarai, B; Prasad, JN; Shah, SPABSTRACT Background Transversus abdominis plane block (TAP) has been shown to produce effective pain relief following lower abdominal surgeries but is yet to be routinized in different type of surgeries including appendectomy. The main risk of visceral injury can be logically avoided when the block is performed with the abdomen open using landmark technique in the absence of ultrasound guidance. Objective To assess the effectiveness of TAP block with bupivacaine for postoperative analgesia using landmark technique (performed with the abdomen open) in adult patients undergoing appendectomy. Method Forty patients undergoing appendectomy were randomized to undergo ipsilateral TAP block with bupivacaine (n=20) versus control (n=20) in addition to standard postoperative analgesia. All patients received standard general anaesthesia. The block was performed using the landmark technique with 20 ml of 0.5% bupivacaine or isotonic saline on ipsilateral side just before abdominal closure. Pain severity was measured using Visual Analogue Scale (VAS). Tramadol 50 mg was administered as rescue analgesic intravenously when VAS was four or more postoperatively. The duration of analgesia and the requirement of tramadol in 24 hours postoperatively were recorded. Result Mean duration of analgesia in the TAP block with bupivacaine was longer as compared with placebo (724.00±299.07 min vs 168.25±55.18 min; p< 0.01). The TAP block with bupivacaine compared with saline significantly reduced postoperative VAS pain scores. Mean tramadol requirement in the first 24 hours was also reduced (42.50±37.25 mg vs 120.00±55.18 mg; p<0.01). There were no significant complications attributable to the TAP block. Conclusion Ipsilateral TAP block with bupivacaine using landmark technique with the abdomen open in appendectomy provides effective postoperative analgesia and opioids sparing effect. KEY WORDS Ipsilateral, landmark technique, postoperative analgesia, transversus abdominis plane blockPublication Thyroid Angiosarcoma : An unusual and challenging case report at B.P. Koirala Institute of Health Sciences(Kathmandu University, 2025) Lamichhane, U; Paudyal, P; Karki, S; Pradhan, A; Dahal, M; Shah, SPABSTRACT Angiosarcoma is an uncommon malignant vascular tumor of endothelial origin and commonly described in soft tissue. Thyroid is an uncommon site for angiosarcoma and is a very aggressive tumor commonly occurring in elderly female, characterized by its prevalence in Alpine regions of central Europe. The main aim of this case report is to provide an insight on thyroid angiosarcoma (TAS) occurring in non- Alpine region, to know the major diagnostic features of thyroid angiosarcoma and distinguish it from anaplastic thyroid carcinoma with angiomatoid features. Due to its overlapping microscopic features diagnosis of primary thyroid angiosarcoma (TAS) was challenging. However, the combination of thorough microscopic findings and immunohistochemical studies (CD 31, Vimentin, Thyroglobulin and Thyroid Transcription Factor-1) are vitally important in differentiating these two tumors to achieve at a final diagnosis. This significantly helps to decide the best treatment option and predict the behaviour. KEY WORDS Anaplastic carcinoma, Angiosarcoma, Thyroid glandPublication Vitamin D Deficiency and Acute Otitis Media among Children Visiting a Tertiary Care Centre in Eastern Nepal(Kathmandu University, 2023) Dahal, R; Shah, SP; Mishra, S; Baaniya, BABSTRACT Background There have been various studies to draw out the association between acute otitis media (AOM) and vitamin D deficiency but the results are conflicting. Objective To explore the relationship between vitamin D deficiency and acute otitis media. Method The comparative cross-sectional study was conducted in which children aged five to fifteen years were included. Sixty children diagnosed with acute otitis media were kept in group A while 60 children diagnosed with conditions other than acute otitis media were included in Group B. Then the Vitamin D level was sent in both the groups and compared. Result Fifty-four participants in group A had an insufficient level of Vitamin D while six participants had a sufficient level of Vitamin D and none had an excess level of Vitamin D while in Group B, fiftywo participants had an insufficient level of Vitamin D while eight participants had a sufficient level of Vitamin D. The mean vitamin D of the cases was 22.12 ±7.896 ng/ml, and that of the controls was 22.58 ±7.056 ng/ml for the controls (p = 0.737). Conclusion Both the children with acute otitis media and without acute otitis media had lower levels of Vitamin D in similar proportions. Therefore, we can conclude that there is no association between Vitamin D level and acute otitis media. KEY WORDS Acute otitis media, Children, Vitamin D