Journal Issue: No 3, Issue 23, JULY-SEPT, 2008
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Volume
Number
Issue Date
2008
Journal Title
Journal ISSN
1812-2027
Journal Volume
Articles
Are we really in safe hands? How safe is safe?
(Kathmandu University, 2008) Pradhan, R; Shrestha, K; Gurung, S
NA
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.
Treatment of supracondylar fracture of the humerus (type IIB and III) in children: A prospective randomized controlled trial comparing two methods
(Kathmandu University, 2008) Pandey, S; Shrestha, D; Gorg, M; Singh, GK; Singh, MP
Abstract
Background: Consensus on method of treatment of displaced supracondylar fracture of the humerus in children is still
lacking. Purpose of this prospective randomized controlled study is to compare closed reduction and long arm slab
application with closed reduction and percutaneous crossed Kirschner wires xation.
Materials and methods: Children of age less than 12 years presented in B.P. Koirala institute of health sciences, Dharan
in one year were randomly allocated to group A and group B consisting 30 patients in each group. Closed reduction and
long arm posterior slab was applied in group A and in group B, closed reduction was followed by crossed Kirschner
wires xation. Clinical and radiological evaluation of reduction was performed immediately after procedure and at the
end of rst week, third week, third month and sixth month.
Results: The groups were matched for pre fracture characteristics and post reduction evaluation. The mean follow up
period in group A was 6.9 months and in group B was 7.1 months. Closed reduction failed in two patients at the rst
attempt and one patient failed to retain reduction at rst week in group A. 11 patients (5 in group A and 6 in group
B) were lost to follow up. Range of movement, valgus, varus and carrying angle of elbow in two groups were not
signi cantly different. The mean difference of carrying angle of affected elbow as compare to normal elbow was
signi cant in group A (p 0.05). Flynn’s overall rating showed 32% excellent, 36% good, 18% fair and14 % poor result
in patents treated with long arm slab as compared to 58% excellent, 29% good, 13 % fair and no poor results in patients
with crossed Kirschner wires xation.
Conclusion: The outcome of displaced extension type supracondylar fracture of the humerus in children, managed with
closed reduction and slab application are comparable with closed reduction and crossed Kirschner wire xation in terms
of range of motion but is inferior in restoration of carrying angle. Good to excellent cosmetic and functional results are
higher with crossed percutaneous Kirschner wires xation than with slab immobilization.
Key words: closed reduction; percutaneous xation; supracondylar fracture
Antiemetic prophylaxis against postoperative nausea and vomiting with ondansetron-dexamethasone combination compared to ondansetron or dexamethasone alone for patients undergoing laparoscopic cholecystectomy
(Kathmandu University, 2008) Gautam, B; Shrestha, BR; Lama, P; Rai, S
Abstract
Background: Postoperative nausea and vomiting (PONV) is a common distressing experience in patients following
laparoscopic surgeries. This study was aimed at comparing the ef cacies of Ondansetron-Dexamethasone combination
with each drug alone as a prophylaxis against PONV in patients after elective laparoscopic cholecystectomy done under
general anaesthesia.
Materials and methods: Hundred and fty ASA I and II patients, aged 23 to 65 yrs, were enrolled in this prospective,
randomized, double-blind trial to receive one of three treatment regimens: 4 mg Ondansetron (Group O), 8 mg
Dexamethasone (Group D) or 4 mg Ondansetron plus 8 mg Dexamethasone (Group OD) (n=50 for each). A standardized
balanced general anaesthetic technique was employed. Any episode of PONV and need for rescue antiemetic were
assessed at six, 12 and 24 hrs post operation. Complete response was de ned as no PONV in 24 hrs and need for rescue
antiemetic was considered as failure of prophylaxis. Pain scores, time to rst analgesia demand, amount of Meperidine
consumption, adverse event(s) and duration of hospital stay were recorded.
Results: Complete response occurred in 66.7, 66.0 and 89.4% in Groups O, D and OD respectively. Rescue antiemetics
were required in 29.2, 31.9 and 8.5% of patients in Groups O, D, and OD respectively. Signi cantly high incidence of
vomiting and failure of prophylaxis (19.1%) occurred in group D during the rst six hrs (P=0.023 versus O & 0.008
versus OD). More frequent antiemetic rescue was required in group O at 6 to 24 hr interval as compared to group OD
(P=0.032).
Conclusion: Combination of Ondansetron and Dexamethasone is better than each drug alone in preventing PONV
after laparoscopic cholecystectomy. Dexamethasone alone is signi cantly less effective in preventing early vomiting
compared to its combination with Ondansetron; whereas Ondansetron alone is less effective against late PONV as
compared with combination therapy.
Key words: Antiemetic prophylaxis; Dexamethasone; laparoscopic cholecystectomy; Ondansetron; postoperative
nausea and vomiting (PONV)