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Article
Evaluation and Comparison the Efficacy of Bupivacaine Socked Spongostan and Bupivacaine Infiltration in Relieving Post Episiotomy Pain
تقييم ومقارنة فاعلية تنقيع السبونجوستان بعقار البيوبوفكين مع ارتشاح عقار البيوبوفكين في ازالة الام قص العجان

Authors: Najah Shaker Yassen د. نجاح شاكر ياسين --- Nadia Ridha د. نادية رضا
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2012 Volume: 25 Issue: 4 Pages: 308-313
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Back ground: The perineal pain resulting from episiotomy is a stressful factor in mothers, which interferes with their ability of nursing and doing their duties as a mother and may interfere with urination and defecation.Aim of the study: To evaluate and compare the efficacy of adding spongostan socked with bupivacaine at episiotomy bed, or 0.5% bupivacaine infiltrated alone with 1% of lidocaine( served as control) in relieving post episiotomy pain.Patients and method: A prospective comparative study was conducted at department of obstetrics and gynecology in Baghdad teaching hospital during the period of the first of January 2010 till the end of December 2010.During the period of the study a150 women had vaginal deliveries with mediolateral episiotomy and met the inclusion criteria after obtaining informed consent were recruited in the study and enrolled into 3 groups assigned as first group including 50 women receiving only 1% lidocaine locally infiltrated at episiotomy site served as control group , second group including 50 women receiving in addition to the local 1% lidocaine a 0.5 % bupivacaine infiltrated at episiotomy sit at the end of the reconstruction of their episiotomy , finally the third group including 50 women receiving 1% lidocaine infiltration at episiotomy site but prior to repair , an absorbable gelatin sponge (spongostan) soaked with 0.5% bupivacaine placed in the episiotomy bed without suturing matched with the length of episiotomy then continuo the suturing procedure .Results: In visual analog scale( VAS) At 0 hour, the pain score for the spongostan group(1.98±0.95) was significantly more than the score of Bupivacaine group (1.54±0.73) the P value <0.05 but significantly less than the lidocaine group (5.72±0.88) P value<0.05 ., Then the pain scores at 1, 1.5, 2, 6,and 24 hour for the spongostan group (0.66±0.62, 0.24±0.43, 0.18±0.38, 0.46±0.54, 0.86±0.35 respectively) were significantly lower than the bupivacaine group(1.04±0.57, 0.64±0.48, 0.56±0.50, 2.18±0.48, 3.16±0.79) P value<0.05 and the lidocaine group (3.54±0.81, 3.10±0.81, 3.54±0.61, 3.44±0.64, 2.42±0.53) the P value<0,05., Also the pain scores for the bupivacaine group at 1, 1.5, 2, 6, and 24 hour were significantly lower( 1.04±0.57, 0.64±0.48, 0.56±0.50, 2.18±0.48, 3.16±0.79) than the pain scores of lidocaine group(3.54±0.81, 3.10±0.81, 3.54±0.61, 3.44±0.64, 2.42±0.53) the P value<0.05. The analgesia requirement time for spongostan group (0.00) was significantly less than the bupivacaine (10.06±2.37) and the lidocaine groups (1.80±0.86) P value<0.05. Also The analgesia requirement time for the bupivacaine group (10.06±2.37) was significantly less than the lidocaine group (1.80±0.86).P value < 0.05, The analgesic doses required per 24 hour for the spongostan group (0.00) was significantly less than the Bupivacaine (1.00±0.00) and the lidocaine groups (1.98±.318) the P value<0.05 As well as the bupivacaine group(1.00±0.00) , showed a significantly less analgesic doses than the lidocaine group (1.98±.318) P value <0.05 Conclusions:1.The addition of 0.5% bupivacaine at episiotomy sit had significantly less pain score and analgesic requirement than infiltration of 0.1% of lidocaine alone2.But the adding of spongostan socked with bupivacaine at episiotomy bed is more superior in pain relieve than bupivacaine or lidocaine aloneKey words: episiotomy, spongostan, bupivacaine

الملخصالمقدمة: إن آلام منطقة العجان الناتجة من عملية قص العجان هي من العوامل المجهدة لدى إلام لأنها تعيق قدرتها من الاعتناء بوليدها أو واجباتها الأخرى و كذلك قد تؤثر على عملية الإدرار أو التغوط الهدف من الدراسة: لتقييم و مقارنة فاعلية إضافة سبونجوستان منقوع بعقار البيوبوفكين يوضع في منطقة العجان قبل خياطة المنطقة مع عقار البيوبوفكين لوحده (بدون سبونجوستان)مع نساء تم إعطائهن فقط عقار الليدوكائين ( كمجموعة مقارنة) في إزالة الآلام المصاحبة لقص العجان.مكان البحث: تم اجراء البحث في قسم النسائية و التوليد في مستشفى بغداد التعليمي خلال الفترة منذ بداية شهر كانون الثاني لغاية شهر كانون الاول لسنة 2010تصميم الدراسة: مستقبلية مقارنةالمرضى و الطرائق: خلال فترة البحث تم اخذ مئة و خمسون امرأة من اللواتي تمت ولادتهن بمساعدة قص العجان و انطبقت عليهن مواصفات الدخول الى البحث بعد اخذ موافقتهن . تم ترتيب النساء عشوائيا في ثلاثة مجاميع :المجموعة الأولى اشتملت على خمسون امرأة استلمت 1% من عقار الليدوكائين اثناء عملية قص العجان ( اخذن كمجموعة مقارنة) ,المجموعة الثانية اشتملت على خمسون امرأة استلمن بالاضافة الى 1% من عقار الليدوكائين اثناء قص العجان الى ارتشاح عقار البيوبوفكين 0.5% في منطقة العجان مباشرة بعد خياطته بينما المجموعة الثالثة اشتملت على خمسون امرأة اخريات استلمن اضافة الى 1% من عقار الليدوكائين اثناء قص العجان ,سبونجوستان منقوع بعقار البيوبوفكين 0.5% في منطقة العجان قبل خياطته. تم قياس السبونجوستان و مقارنته مع قياس منطقة العجان وكل سنتمتر من السبونجوستان نقع ب(1 مللتر) من عقار البيوبوفكين 0,5% .النتائج: تمت متابعة النساء حول الالم مابعد خياطة العجان ومقارنة الالم مع الحاجة الى المهدئات بين المجاميع ووجد ما يلي: في ساعة الصفر من المتابعة كانت علامات الالم عند النساء اللواتي استلمن السبونجوستان المنقوع بعقار البيوبفكين اكثر من النساء اللواتي ارتشحن بعقار البيوبفكين P value <0.05 ولكن اقل من اللواتي استلمن عقار الليدوكائين فقط، اما علامات الالم في الساعات التالية: "1" "1,5" "2" 6" و24ساعة وجدنا ان المجموعات التي استلمت سبونجستان منقوع بعقار البيوبفكين كانت اقل من مجموعة البيوبوفكين P value<0,05 ومجموعة الليدوكائين فقط P value<0,05 الاحتياج الى المهدئات لدى مجموعة السبونجوستان المنقوع بالبيوبفكين كانت (0,00) ذات جدوى احصائي اقل من مجموعة ارتشاح البيوبفكين 0,5% ومجموعة الليدوكائين P value<0.05وكذلك الاحتياج الى المهدئات لدى مجموعة البيوبفكين 0,5% ولدى مجموعة الليدوكائين خلال 24 ساعة.الاستنتاج:1.ان ارتشاح 0,5%من عقار البيوبفكين في منطقة العجان يقلل علامات الالم بجدوى احصائية اكثر من اللواتي استلمن فقط الليدوكائين.2.لكن اضافة السبونجستان المنقوع بعقار البيوبوفكين في منطقة العجان تتفوق على لارتشاح بعقار البيوبفكين فقط في ازالة الالم مابعد خياطة العجان.

Keywords

episiotomy --- spongostan --- bupivacaine


Article
Epidural Labor Analgesia during the First Stage of Labor: A Double-Blind Clinical Trial

Author: Ali Hadi Muslih
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2012 Volume: 11 Issue: 1 Pages: 20-23
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: although severe pain is not life-threatening in healthy parturient women, it can have neuropsychological consequences. Postnatal depression may be more common when analgesia is not used, and pain during labor has been correlated with the development of post-traumatic stress disorder. In addition, one study suggested that the impairment of cognitive function in the postpartum period can be mitigated by the use of any form of intrapartum analgesia.Aims: to compare a combination of epidural fentanyl and bupivacaine with bupivacaine alone for epidural analgesia in labor and to evaluate factors in addition to analgesia that may influence maternal satisfaction.Patients and methods: a double blind controlled clinical trial carried on 218 multiparous parturient. The patients were randomly allocated in 2 groups. Group 1 (n=109) had received bupivacaine 0.1% with fentanyl 50µg and group 2 (n=109) (control group) had received bupivacaine 0.1% only.Results: in the bupivacaine group, 40 cases (37.7%) had required 2 top-ups and 26 cases (23.9%) had asked for 3 top-ups. On the other hand 14 (12.8%) cases from bupivacaine fentanyl group had asked for 2 top-ups and no cases had recorded request for 3 doses, which was statistically significant (P<0.0001).Conclusions: maternal satisfactory rate is high in both groups; the bupivacaine fentanyl group had shown a good response to the effect of analgesia with the minimal medical intervention.


Article
Infiltrative Technique in Post-Tonsillectomy Pain Reduction with 0.5% Bupivacaine & 1/200000 Adrenaline
طريقةارتشاح البيوبيفاكين 0.5% مع الادرينالين 1/200000 في تقليل الالم الناتج من عملية استئصال اللوزتين

Author: Nasir U. Hassen د. ناصراسامة حسن
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2010 Volume: 23 Issue: 3 Pages: 204-207
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Background Tonsillectomy is one of the commonly performed surgical procedures in otolaryngology. Postoperative morbidity, including pain, bleeding, inadequate oral intake and dehydration can create problems. Pain after tonsillectomy still remains to be a frequent problem. In an effort to reduce post-tonsillectomy morbidity, numerous modifications and adjuncts to standard surgical technique have been proposed. Objective: To determine the effectiveness of 0.5% bupivacaine and 1/200000 adrenaline in post tonsillectomy pain using an intra-individual design.Methods: 47 patients aged 8-35 years were included in a prospective study, diagnosed clinically as chronic tonsillitis in Karama teaching hospital. Patients received a local infiltration of 0.5% bupivacaine and 1/200000 adrenaline solution on the right tonsillar bed, and received a local infiltration of normal saline on the left tonsillar bed as control, at the end of the operation in the theatre. Postoperative pain was assessed with a visual analog scale at 4,6,8,12,24 hours after the procedure.Result: According to visual analog scale results, the severity of pain was less in the site infiltrated with 0.5 bupivacaine and 1/200000 adrenaline than the site infiltrated the normal saline.Conclusion: local 0.5% bupivacaine and 1/200000 adrenaline infiltration in tonsillar bed can reduce post tonsillectomy pain.Key ward: Bupivacaine, Tonsillectomy Pain, Local anesthesia.

خلفية البحث:تعتبر عملية استئصال اللوزتين من اكثر العمليات التي تجرى في قسم الانف والاذن والحنجرة.ان العواقب ما بعد العملية هي : الالم , النزف , صعوبة تناول السوائل عن طريق الفم و فقدان سوائل الجسم.هناك جهد كبير من اجل تقليل عواقب الالم ما بعد العملية وتحويرات كثيرة في عمليات استئصال اللوزتين.الهدف:تحديد فعالية البيوبيفاكين 0.5% مع الادرينالين 1/ 200000 في التاثير على الالم ما بعد استئصال اللوزتين.الطريقة:اجري البحث على 47 مريضا, اعمارهم ما بين (8-35) سنة , دراسة تطلعية في مستشفى الكرامة التعليمي على مرضى يعانون من التهاب اللوزتين المزمن و تم علاجهم بعملية استئصال اللوزتين, تم اعطائهم البيوبيفاكين 0.5% مع الادرينالين 1/ 200000 في الجهة اليمنى من موقع اللوزتين , والمحلول المتعادل الملوحة في الجهة اليسرى من موقع اللوزتين عند نهاية العملية. تم تقييم الالم بعد العملية بواسطة مقياس التدرج المماثل البصري في24,12,8,6,4 ساعة.النتائج:استنادا الى نتائج مقياس التدرج المماثل البصري شدة الالم كان اقل في جهة الارتشاح بالبيوبيفاكين 0.5% مع الادرينالين 1/ 200000 عن الجهة التي تم وضع المحلول المتعادل الملوحة.الاستنتاجات:الزرق الموضعي بالبيوبيفاكين 0.5% مع الادرينالين 1/ 200000 بواسطة الارتشاح في موضع اللوزتين يقلل الالم بعد العملية.


Article
Post Operative Effect of Bupivacaine as Local Anesthesia in Abdominal Incisions

Author: Safa M.Al-Obaidi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2008 Volume: 7 Issue: 3 Pages: 209-214
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACK GROUND:Pain after abdominal incisions is responsible for many postoperative problems, especially pulmonary and thromboembolic complications. Although many analgesic drugs are available yet they have to be given systemically to be effective with a real danger of respiratory depression.The use of local anesthetic drug infiltrated in the wound at the end of surgery is a logical solution .The aim of this study is to evaluate the effect of local anesthesia in the control of postoperative painMETHODS:During the period January 2007 until December 2007 hundred and twelve patients had abdominal operations at Baghdad Teaching hospital .Patients were randomly allocated to two groups .Group (1) included 56 patients who had 10 ml bupivacaine infiltrated in the wound by a sub facial catheter before wound closure and Group (2) 56 patients had placebo injected (2 ml of normal saline).Visual analogue scale was used for post operative pain assessmentRESULTS:There was a significant decrease in pain score and the requirement of the systemic analgesic in Group (1) during the 1st 24h after surgery as compared to Group (2) with (P. < 0.05) .The type of surgery which showed marked decrease in pain score were repair of hernia, open cholecystectomy and appendesectomy and was least obvious after midline incision.CONCLUSION:There was a significant decrease in pain intensity and the analgesic requirement in patients who had local wound infiltration with bupivacaine as compared to placebo group thus making it an effective, simple and cheap method in relieving pain after abdominal incisions.


Article
A comparison Between the Transversus Abdominis Plane (TAP) Block Versus Traditional Parentral Analgesia Post Caesarian Section

Authors: Iyad Abbas Salman --- Hayder Saad Kamel
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2012 Volume: 11 Issue: supplement Pages: 718-723
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Postoperative pain, especially when poorly controlled, results in harmful acute effects (i.e., adverse physiologic responses) and chronic effects (i.e., delayed long-term recovery and chronic pain).The transversus abdominis plane (TAP) block is a new method of providing postoperative analgesia in patients undergoing lower abdominal wall incisionsOBJECTIVE:To compare the effectiveness of TAP block versus traditional parenteral analgesia post caesarian section.PATIENTS AND METHODS:A prospective randomized double blinded placebo controlled clinical trial conducted in the department of obstetrics & gynecology of medical city complex. over a period of four months from 1st of November to 1st of march. Fifty women patients were selected to be enrolled in this study who were scheduled for C.S. via pfannenstiel incision, all patients were of ASA I- II physical status. Twenty five of them were given TAP block with (bupivacaine 0.25%) & placebo i.v saline (0.9%) , the other twenty five were given i.v tramadol & i.m diclofinac sodium & placebo TAP block with normal saline 0.9%.Numerical rating scale was used to follow up the patients postoperatively at 2,6,12,16 hours.RESULTS :By comparing the means of numerical analogue scale score over the time there was a significant difference in mean score over the time, the traditional treatment had better effect on relieving pain only at the 1st 2 hours where TAP block was better on the rest time with a highly significant difference P.value < 0.05 in all comparisons.CONCLUSION:TAP block is not effective as sole analgesic, but is effective in reducing the frequency of doses of incremental analgesia. TAP block is more effective than traditional analgesia in reducing the mean of pain score .The traditional parentral analgesia require more frequent dosing.


Article
Intrathecal Ketamine Versus Bupivacaine for Inguinal Hernia Surgery

Author: Aimen Hameed Latef
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 4 Pages: 477-481
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Ketamine shows beside its general anesthetic effect, a local anesthetic - like action; that is due to blocking of Na+ channels mainly with other proposed mechanisms.OBJECTIVE:Comparison of ketamine local anesthetic action with that of bupivacaine in neuraxial blockage (spinal anesthesia) was done.PATIENTS AND METHODS:Hundred patients were scheduled according to American Society of Anesthesiologists (ASA) physical status classification I-II for elective inguinal hernia surgery under spinal anaesthesia, divided into 2 equal groups, the first group received 2 ml (0.5%) bupivacaine, second group received 2 ml [75 mg preservative free Ketamine (1.5 ml) mixed with 0.5 ml, 30%dextrose], comparison in the onset, duration of the sensory block and the central sedative effect between the two groups was done.RESULTS:Group II patients who received ketamine intrathecally demonstrated faster onset of block with longer duration of analgesia, 30% of them appeared sedated owing to the central sedative effect.CONCLUSION:As a new look to an old drug; ketamine can be used as a pure local anesthetic for spinal anesthesia with the advantage of longer period of analgesia and faster onset as compared with bupivacaine. Ketamine group appeared more hemodynamically stable.


Article
Hemodynamic Changes During Spinal Anesthesia For Elective Cesarean Section With Hyperbaric Bupivacaine: Effect Of Volume And Concentration
التغيرات في جهاز الدوران أثناء العمليات القيصرية غير الطارئة بأستعمال التخدير الشوكي بواسطة البابيفاكائين الثقيل: تأثير الحجم والتركيز

Author: Ali Nima Hassan
Journal: kufa Journal for Nursing sciences مجلة الكوفة لعلوم التمريض ISSN: 22234055 Year: 2015 Volume: 5 Issue: 3 Pages: 98-104
Publisher: University of Kufa جامعة الكوفة

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Abstract

Background: Spinal anesthesia for cesarean section with hyperbaric Bupivacaine is widely used. The course of the procedure is frequently troubled by hemodynamic instability that is determined by the level of spinal block and this in turn depends on the spread of the local anesthetic within the CSF. By fixing the dose of the local anesthetic any increase in its volume leads to a decrease in its concentration because these factors are closely related to each other and they can affect the spread of the local anesthetic.Objective: To compare between large volume but lower concentration (4 ml of 0.25%) and small volume but higher concentration (2 ml of 0.5% ) of hyperbaric Bupivacaine solutions used for spinal anesthesia for elective cesarean section in respect to hemodynamic changes.Method: A clinical interventional study was Performed at Al-Zahra'a Teaching Hospital (Najaf ) from 18th Jun.-18th Jul. 2013. Forty patients scheduled for elective cesarean section were randomly selected and randomly divided into two equal groups (A and B). Both groups received hyperbaric Bupivacaine via intrathecal route, group (A) received 4 ml of 0.25% solution while group (B) received 2 ml of 0.5% solution. Hemodynamic variables (blood pressure and heart rate) were recorded throughout the time of anesthesia. Data was analyzed by using SPSS version 20.Results: There was no significant difference in the incidence of hypotension (P value=1.0) between the two groups while the incidence of bradycardia was equal between the two groups (10%) but there was a need for significantly higher average dose of Ephedrine that was used to treat hypotension in group (A) than in group (B) (P value=0.49%) reflecting more severe hypotension in group (A) than group (B).Conclusion: we conclude that the volume factor has more influence than the concentration on blood pressure with regard to hyperbaric intrathecal Bupivacaine solutions used for elective cesarean section.Recommendation: the use of smaller volume but higher concentration of intrathecal Bupivacaine is advisable in elective cesarean section.

خلفية البحث: يستعمل التخدير النصفي بواسطة دواء البابيفاكائين الثقيل للعمليات القيصرية على نطاق واسع. يعاني جهاز الدوران أثناء هذا النوع من التخدير من تغيرات مهمة يعتمد حصولها على المستوى الذي يصل اليه الدواء في الحبل الشوكي والذي يحدده أنتشار الدواء داخل السائل الشوكي. بتثبيت الجرعة فأن أي زيادة في الحجم تؤدي الى تقليل تركيز الدواء لأن هذه العوامل مرتبطة مع بعضها ارتباطا وثيقا وكل عامل بمفرده يؤثر بدرجة معينة على أنتشار الدواء داخل السائل الشوكي.الهدف: المقارنة بين الحجم الأكبر بتركيز أقل (4 ملل وتركيز 0,25%) والحجم الأصغر بتركيز أعلى (2 ملل وتركيز 0,5%) لمحاليل البابيفاكائين الثقيل في التخدير الشوكي (النصفي) للعمليات القيصرية غير الطارئة من حيث التأثير على جهاز الدوران.المنهجية: تم أجراء دراسة تداخلية سريرية في مستشفى الزهراء التعليمي في النجف من 18 حزيران ولغاية 18 تموز 2013. تم اختيار عينة عشوائية مكونة من أربعين مريضة ستجرى لهن عمليات قيصرية غير طارئة حيث قسمت العينة عشوائيا الى مجموعتين متساويتين (أ,ب). كلا المجموعتين أعطيت البابيفاكائين الثقيل داخل السائل الشوكي, المجموعة (أ) بحجم 4 ملل بتركيز 0,25% بينما المجموعة (ب) بحجم 2 ملل بتركيز 0,5% . تم تسجيل متغيرات جهاز الدوران (ضغط الدم و معدل ضربات القلب) خلال وقت التخدير. أنجزت التحاليل الإحصائية بواسطة برنامج (SPSS version 20).النتائج: لم يلاحظ أي اختلاف مهم في نسبة حصول انخفاض ضغط الدم (P value=1.0) بين المجموعتين كما كانت نسبة حصول تباطؤ معدل ضربات القلب متساوية بين المجموعتين (10%) ولكن لوحظ أن معدل جرعة دواء الأقدرين المستخدم لمعالجة انخفاض ضغط الدم كانت أعلى في المجموعة (أ) من المجموعة (ب) (P value=0.49%) مما يعني أن شدة انخفاض ضغط الدم في المجموعة (أ) أكثر من المجموعة (ب).الأستنتاج: نستنتج من هذا البحث أن عامل الحجم له تأثير أكبر من عامل التركيز على ضغط الدم بالنسبة لمحلول البابيفاكائين الثقيل المستخدم في التخدير الشوكي (النصفي) للعمليات القيصرية غير الطارئة.التوصيات: ينصح باستعمال دواء البابيفاكائين الثقيل بحجم أقل وتركيز أعلى للتخدير الشوكي (النصفي) في العمليات القيصرية غير الطارئة.


Article
A Comparison of Bupivacaine Instillation and Ultrasound Guided Field Block for Post-Operative Pain Relief in Inguinal Hernia Repair

Author: Iyad Abbas Salman* , Ali Moayed Jwad
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2017 Volume: 16 Issue: 3 Pages: 248-251
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Postoperative pain is a common problem after inguinal hernia repair. Postoperative pain may delay the return to normal activity and delay hospital discharge. Various techniques have been employed to provide postoperative analgesia, by the use of regional anesthetic technique, local anesthesia or traditional analgesic technique: opiates, non-steroidal anti-inflammatory drugs (NSAIDs) or combinations.OBJECTIVE: To compare the postoperative pain relief provided by simple bupivacaine wound instillation and ultrasound guided inguinal hernia field block.PATIENT AND METHOD: A single blind, prospective, randomized controlled clinical trial for 72 male patients who were undergoing elective unilateral inguinal hernia repair. In 37 of them 10 ml of 0.5% plain bupivacaine was instilled (irrigated) into the wound by the surgeon for 1 minute. In another 35 patients, ultrasound guided field block performed using 20 ml of 0.25% plain bupivacaine at the end of surgery. Vital signs, numerical pain score and analgesia requirement were recorded at recovery (zero hour), 1st, 2nd, 4th& 8th hours postoperatively.RESULT: By applying null hypothesis, using the t-student test of two independent samples, pain score and request for analgesia show significant difference only at the first two hours with p-value <0.05, otherwise there was no significant differences in the following hours. For vital signs there was no significant difference for both groupsCONCLUSION: Bupivacaine instillation is as effective as ultrasound guided field block for inguinal hernia repair pain. We recommend this technique in places where ultrasound machine is not available especially in many developing countries.


Article
Effect of Midazolam on Bupivacaine Action in Intrathecal Anesthesia

Author: Anas Amer M. Ajam, Ramadhan Jaafer Guri
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2018 Volume: 15 Issue: 1 Pages: 43-47
Publisher: Babylon University جامعة بابل

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Abstract

Background: Subarachnoid anesthesia is regarded as one of the famous neuroaxial block procedures available nowadays. Neuraxial anesthesiaoffers many benefits over general anesthesia. Objective: This study is designed to compare the effect of adding 1 and 2 mg midazolam tohyperbaric bupivacaine on duration of sensory and motor block and intraoperative hemodynamic changes for the cesarian section undersubarachnoid anesthesia. Methods: Ninety patients with the American Society of Anesthesiology Classifications I/II (range: 18–40 years)were randomly allocated into three groups and were underwent spinal anesthesia for Cesarean Section in Duhok Maternity Hospital, Iraq.Group A (n = 30) received intrathecal of bupivacaine 12.5 mg + 0.4 ml of normal saline, Group B (n = 30) intrathecal of bupivacaine 12.5 mg+ 1 mg midazolam, and Group C (n = 30) intrathecal of bupivacaine 12.5 mg + 2 mg midazolam. The study groups were comparable in ageand hemodynamic status changes prior and intra-intervention commencement. Results: The analgesic duration of those patients in GroupsC and B were significantly longer, 183.33 and 181.00 min compared to 138.00 min in Group A for motor block (P < 0.0001) and 212.00,210.00, and 142.00 min, respectively, for sensory block (P < 0.0001) with no any substantial difference in hemodynamic status changes.Conclusion: The longer duration of analgesic was found using midazolam adjuvant with bupivacaine compared to free adjuvant group inwomen underwent spinal anesthesia.


Article
The Effect of Placing 0.5% Bupivacaine-Soaked Gelfoam in the Gallbladder Bed on Pain after Laparoscopic Cholecystectomy
تأثير وضع الجلفوم بنسبة 0.5 ٪ في بوبيفاكايين المنقوع في قاع المرارة على الألم بعد استئصال المرارة بالمنظار

Authors: Ali A. Al-Dabbagh --- Saeed Dakheel Saeed
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2009 Volume: 13 Issue: 1 Pages: 24-30
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objective: Patients undergoing laparoscopic cholecystectomy (LC) experiences post operative abdominal pain. This study aimed to determine the character of pain after LC and its relief with 0.5% bupivacaine-soaked gelfoam placed in the gallbladder bed.Methods: A prospective randomized, double blinded placebo-controlled study was conducted on 200 patients with chronic cholecystitis, patients were divided into four groups of 50 patients :group A (2 mg/kg 0.5% bupivacaine-soaked gelfoam kept in gallbladder bed), group B (2 mg/kg 0.5% bupivacaine infiltrated at trocar sites), group C ( 1/2 of the required dose of 2 mg/kg 0.5% bupivacaine infiltrated into the gallbladder bed and at trocar sites, and group D (normal saline in the gallbladder bed and at trocar sites). Postoperatively, the character of pain was noted, and its relief was assessed with verbal rating scale (VRS) scoring.Results: 77.50% of the patients had visceral, 60.50% had parietal, and 23.50% had shoulder pain postoperatively. The visceral pain was significantly less in group A patients than in the control patients (p < 0.01),the mean VRS score at 4, 8, 12 and 24 h in the group A patients also was less than in control group D. Trocar-site infiltration alone was not effective in relieving the parietal pain.Conclusions: Visceral pain is prominent after laparoscopic cholecystectomy and can be effectively controlled by 0.5% bupivacaine-soaked gelfoam in the gallbladder bed alone.

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