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A COMPARATIVE STUDY OF GLYCOPYRROLATE AND DEXAMETHASONE IN THE CONTROL OF PONV AFTER INTRATHECAL FENTANYL AND BUPIVACAINE FOR CAESAREAN SECTION.
TABLE OF CONTENT
Cover Page – – – – – – – – – – i
Declaration – – – – – – – – – – ii
Certification – – – – – – – – – – iii-vi
Table of Contents – – – – – – – – – vii-viii
List of Tables – – – — – – – – – – ix
List of Figures – – – – – – – – – – x
List of abbreviations – – – – – – – – – xi-xii
Dedication – – – – – – – – – – xiii
Acknowledgment – – – – – – – – – xiv
Summary – – – – – – – – – – 1-2
Chapter One
Introduction – – – – – – – – – 3-5
Chapter Two
Aim and Objectives – – – – – – – – – 6
Chapter Three
Literature Review – – – – – – – – – 7-22
Chapter Four
Patients and Methods – – – – – – – – 23-29
Chapter Five
Results – – – – – – – – – – 30-50
CHAPTER SIX
Discussion – – – – – – – – – – 51-57
Conclusion – – – – – – – – – – 58
Recommendations – – – – – – – – – 59
Limitations – – – – – – – – – – 60
References – – – – – – – – – – 61-72
Appendix i. Ethical Clearance – – – – – – – 73
Appendix ii. Proposal Approval – – – – – – – 74
Appendix iii. Written informed consent Form – – – – – 75-77
Appendix iv. Data Collection Form – – – – – – – – 78-81
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EVALUATION OF THE INCIDENCE OF CENTRAL VENOUS CATHETER LINE INFECTION IN PATIENTS ADMITTED IN THE INTENSIVE CARE UNITS OF UNTH ENUGU: RISK FACTORS AND MICROBIOLOGY PROFILE
ABSTRACT
Background: University of Nigeria teaching hospital has two functional intensive care units(ICU), each is a 5 bedded ICU. Patients admitted in the intensive care unit often require the insertion of various invasive devices such as Central venous catheter, and arterial line for monitoring and therapeutic interventions. These devices though indispensable in the management of these patients in ICU but often puts them at risk of various iatrogenic complications and central venous catheter blood stream infection resulting in prolonged hospital stay, increase morbidity, mortality and cost.
Objective: This prospective observational study was aimed at evaluating the incidence of central venous line infection with its risk factors and microbiology profile among patients in UNTH ICUs. The study was conducted over twelve monthsperiod in the two ICUs of UNTH.
Methodology: Patients admitted into these ICUs, who routinely had CVC inserted in them and met the inclusion criteria were recruited for the study. The first blood sample was collected from each patient and sent for full blood count to ascertain blood sterility. The patients whose blood samples had evidence of infection were excluded as the study was aimed at CVC infection acquired in the ICU. A total of 68 patients were recruited but 65patients completed the study. Blood samples were collected aseptically from a peripheral vein 72 hours after insertion of CVC and at removal of CVC for blood culture. The distal 5cm of the CVC was also collected aseptically when disconnected from patient for catheter tip MCS.
Result:A total of 6(9.2%) of the 65 patients had CVC-BSI while 31(48%) had CVC colonization. 1(2.3%) patients whose duration of catheterization was within 5 days had CVC-BSI while 5(22.7%) whose duration of catheterization was beyond 5days had CVC-BSI. Duration of catheterization was the only risk factors and was statistically significant. A total of 37 organisms where isolated and the commonest bacterial isolate was staphylococcus aureus. The bacterial isolates were mostly susceptible to Gentamycin. The organisms showed a high resistance to the antibiotics tested. All the patients were on prophylactic antibiotic.
Conclusion: It was evident in this study that the incidence of central venous catheter blood stream infection and CVC colonization in ICU of UNTH Enugu was 9% and 31% respectively
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COMPARISON OF INTERVENTIONAL USE OF TRAMADOL AND PETHIDINE FOR THE MANAGEMENT OF SHIVERING DURING SPINAL ANAESTHESIA
ABSTRACT
Back ground:
Shivering occurring under spinal anaesthesia is uncomfortable for patients and places the body under physiologic stress. It can increase oxygen consumption, metabolic rate and cause artifacts on the monitor. The incidence of shivering has been found to be quite high, approximating 40-60% in different studies. In lower limb orthopaedic surgery, regional anaesthesia provides useful benefits such as reduced incidence of peri-operative deep vein thrombosis and better postoperative pain relief compared with general anaesthesia. The deleterious effect of shivering warrant a prompt and rapid control on occurrence.
Aim and Objective:
This study compared the effectiveness of intravenous 0.35 mg kg-1 pethidine and intravenous 0.25 mg kg-1 tramadol in abolishing shivering in patients undergoing spinal anaesthesia for lower limb orthopaedic surgery.
Patients and Methods:
This was a prospective, randomised, double-blinded study conducted in 100 ASA grade I and II eligible patients aged between 15 and 65 years of age who were scheduled for lower limb orthopaedic surgery and shivered during spinal anaesthesia.
All the patients had preloading with warmed normal saline administered at a dose of 10 ml kg-1 . Spinal anaesthesia was induced in the sitting position with 3 mls of 0.5% hyperbaric bupivacaine before being positioned for surgery. When shivering occurred, the patients were given either intravenous 0.35 mg kg-1 pethidine or intravenous 0.25 mg kg-1tramadol based on the group allocation; taking notice of a change in the intensity or dissappearance of shivering as well as haemodynamic parameters such as non-invasive blood pressure, pulse rate, peripheral oxygen saturation and temperature at intervals. Also noted were time to disappearing and recurrence of shivering as well as outcomes such as level of sedation, nausea and vomiting.
Results:
A total of 100 patients met the inclusion criteria and participated in the study out of 394 consecutive patients. The incidence of shivering was 25.38%. Complete disappearance of shivering occurred in 41(82%) patients in the tramadol group compared to 34(68%) in the pethidine group (p=0.0059). Recurrence of shivering after treatment was seen in 10(20%) patients in tramadol group compared to 6(12%) in the pethidine group (p=0.555). The most common side effect noted was nausea occurring in 16(32%) patients in the tramadol group compared to 26(52%) of the pethidine group (p=0.149). A total of 17(34%) patients in the tramadol group had sedation compared to 6(12%) in the pethidine group (p=0.285).
There were no significant differences in the mean arterial pressures, heart rate and axillary temperature of the two groups.
Conclusion:
The result of this study revealed that intravenous 0.25 mg kg-1 tramadol use for abolishing spinal anaesthesia induced shivering is as effective as intravenous 0.35 mg kg-1 pethidine in lower limb orthopaedic surgery, however it’s use is associated with more sedation.
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COMPARISON OF INTRAVENOUS EPHEDRINE WITH PHENYLEPHRINE FOR THE MAINTENANCE OF ARTERIAL BLOOD PRESSURE DURING ELECTIVE CAESAREAN SECTION UNDER SPINAL ANAESTHESIA
ABSTRACT
The aim of this prospective study was to compare the effects
of intravenous bolus of Ephedrine with Phenylephrine for the
maintenance of maternal arterial blood pressure during elective
Caesarean section under spinal anaesthesia. The study population
included sixty two healthy parturients ASA I or ASA II at term with
singleton pregnancy scheduled for elective Caesarean section who
consented to spinal anaesthesia.
Parturients were preloaded with 10ml/kg of crystalloid (Normal
Saline or Ringers lactate) before the induction of spinal anaesthesia
and 2.5 ml of 0.5% hyperbaric Bupivacaine was used for the spinal
anaesthesia. Group A received intravenous bolus Ephedrine 5mg
and Group B, Phenylephrine 100ug for the maintenance of maternal
blood pressure
Hypotension was defined as a decrease in systolic blood pressure
of more than 30% below baseline or below 100mmHg. Bradycardia
was defined as heart rate <60 beats/min.
Patients’ characteristics, spinal block height and baseline
haemodynamic values were similar in the two groups studied.
Seven patients (22.5%) in the Ephedrine group and eight patients
(25.8%) in the Phenylephrine group developed hypotension.
2
Both vasopressors effectively restored the systolic blood pressures
but phenylephrine values were greater than ephedrine values and
was statistically significant in the 15th minute of the procedure, with
p value 0.04. Also, the intra operative diastolic blood pressures
were higher in the phenylephrine group compared to the ephedrine
group, and were significant in the 15th and the 20th minutes of the
procedure with p value of 0.03 and 0.04 respectively.
There was significant difference in heart rate between the two
groups, analysis showed a higher heart rate values in ephedrine
group compared to phenylephrine group which showed a downward
trend with p value ranging from 0.01 to 0.04.
The mean oxygen saturation trends in the two groups were
similar, because all patients had oxygen therapy routinely in this
study, the effect of the vasopressor or spinal anaesthesia could not
be ascertained. Changes in the respiratory parameters showed no
statistical difference between the two groups.
Three patients (9.6%) developed nausea in the Ephedrine
group and 4 (12.8 %) patients in the Phenyephrine group and these
occurred in the hypotensive patients, no patient vomited during the
procedure.
3
There was no need to repeat ephedrine or phenylephrine because
no patient developed refractory hypotension.
The mean APGAR Scores were similar for the two groups; no baby
had Apgar score of < 8 in either group.
In conclusion, Phenylephrine is safe and can be used as
effectively as Ephedrine. It’s administration results in higher blood
pressure values than Ephedrine in parturients undergoing
Caesarean section under spinal anaesthesia.
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A COMPARATIVE STUDY OF CAUDAL BUPIVACAINE AND BUPIVACAINE TRAMADOL FOR ANALGESIA IN PAEDIATRIC INFRAUMBILICAL SURGERIES
ABSTRACT
Background: Caudal analgesia using bupivacaine is commonly used for the relief of pain in
children. Paracetamol and/or non-steroidal anti-inflammatory drugs, commonly oral
ibuprofen, are used for postoperative control of pain, but their analgesic effect is often
insufficient. Opioids on the other hand, administered intravenously, provide effective
analgesia but the fear of their side-effects, especially respiratory depression, emesis and
sedation, have restricted their use. This study evaluated one modality of perioperative
analgesia in children for infra-umbilical surgeries using different drugs, comparing the effect
of addition of caudal tramadol to bupivacaine.
Methodology: This was a prospective, randomized, double-blind study. American Society of
Anesthesiologists (ASA) physical status classes I and II patients were recruited from the
Orthopaedic surgery and Plastic surgery units. The patients were of both sexes, aged between
1 year and 6 years scheduled for elective infra-umbilical surgeries.
Baseline heart rate (HR), non-invasive blood pressure (NIBP), arterial oxygen saturation
(SpO2), respiratory rate (RR), and temperature were measured and recorded. Inhalational
induction using halothane (0.5% increments up to 3%) in 100% oxygen was administered via
a face mask using the Jackson Rees’ modified Ayre’s T piece before intravenous (IV)
cannulation. Venous access was established and IV infusion of lactated Ringers’ solution
mixed with 50% dextrose in water commenced. Aseptic procedure was used in the caudal
administration of preservative-free plain bupivacaine, (National Agency for Food and Drug
Administration and Control (NAFDAC) registration number A4 – 9832) and preservative
free tramadol, NAFDAC approved, ( NAFDAC registration number A4 – 2539) to all the
children using 21-gauge to 23-gauge hypodermic needles. Surgery commenced 15 minutes
after the caudal injection. The patients were randomly assigned to receive 1 ml/kg of 0.25%
bupivacaine (group A) or 1ml/kg of 0.25% bupivacaine plus 1mg/kg of tramadol (group B).
14
Intraoperatively, monitoring of the SpO2, HR, RR, NIBP was recorded every 5 minutes.
Postoperatively, these parameters were recorded every 15 minutes in the first hour and hourly
for another 3 hours. Postoperative pain assessment using Toddler pre-schooler postoperative
pain score (TPPPS), need for additional analgesia and the occurrence of adverse event(s) was
determined and recorded.
Results: One Hundred and Thirty Four patients participated in the study ( A, n = 66 and B,
n = 68). At the point of skin incision, 10 patients (4 in group A, and 6 in group B) recorded
≥15% rise in systolic arterial pressure (SAP) or HR from the baseline values. These patients
were regarded as having had failed caudal block, excluded from the study and their surgeries
concluded under general anaesthesia. The socio-demographic characteristics, ASA status and
duration of surgery were comparable in both groups. The proportion of patients with
significant postoperative TPPPS ≥3 at 3 hours was 20 (32.3%) patients in group A and none
in group B, p = 0.0012. Group B had significant mean duration of analgesia of 10.89 ± 1.10
hours compared with group A of 3.2 ± 1.0 hours, p = 0.0014. The proportion of patients with
incidence of vomiting was 2 (3.23%) in group A which was similar to group B of 3 (4.84%),
p = 0.4702. None of the patients in both groups had motor weakness, urinary retention in the
postoperative period.
Conclusion: The addition of tramadol to bupivacaine for caudal analgesia resulted in longer
analgesia in the postoperative period compared to bupivacaine alone, with acceptable side
effect profile.
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EFFECTS OF VASOCONSTRICTOR ON ARTERIAL BLOOD PRESSURE DURING MINOR ORAL SURGICAL PROCEDURES IN A.K.T.H KANO
ABSTRACT
The aim of this study is to evaluate effect of adrenaline contained in dental local anaesthetics on
blood pressure and pulse rate of patients undergoing extractions. This was conducted in Oral and
Maxillofacial Surgery department of Aminu Kano Teaching Hospital (AKTH), Kano amongst
consenting patients aged 18 to 55 years who are either normotensive or known controlled
hypertensive.
Simple random sampling method was adopted for the study to allocate the patients into either the
study group or the control group using balloting. Sample size of 100(50 per group) was used for
the study. The anxiety level was scored using a numerical scale. Baseline blood pressure and pulse
rate of the patients were measured 5 minutes before the local anaesthetic injection. Two percent
lignocaine with 1:80,000 epinephrine was used in the study group while two percent lignocaine
without epinephrine was used in the control group. A maximum of two cartridges was given to
each patient. Blood pressure and pulse rate were checked 5 minutes after the local anaesthetic
injection, 2 minutes after the commencement of procedure, 15 and 30 minutes after the procedure
using a precalibrated non-invasive electronic digital blood pressure monitor (EchoMax Plus
manufactured by Hubdic Co. Ltd Korea).
Data collection was done by means of interviewer-administered questionnaire and recorded into a
proforma designed for this study. Data was presented using tables, charts and graphs. Quantitative
data was summarized using means and standard deviations, while qualitative data was described
using frequencies and percentages. Data analysis was performed using Statistical Package for
Social Statistics Version 17.0 (SPSS Inc. Chicago, II, USA). The level of significance was
determined using paired t-test. A confidence interval of 95% was used in this study and a p-value
of less than 0.05 was considered significant.
Multivariate logistic regression was done to determine the influence of the socio-demographic
variables, anxiety level, number of anaesthetic cartridge used, and injection technique on the result
of the study.
The results of this study show that there is no statistically significant difference in SBP, DBP, and
PR between the study and control group at all intervals (p-value > 0.05) which points to a
conclusion that the optimal use of local anaesthetics containing adrenaline does not significantly
alter blood pressure in controlled hypertensive and normotensive patients.
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A COMPARATIVE STUDY OF THE EFFECTIVENESS OF ORAL MIDAZOLAM AND ORAL KETAMINE AS SEDATIVE AGENTS IN PAEDIATRIC ORTHODONTIC EXTRACTIONS
ABSTRACT
Procedural fear is a major concern for the paediatric dentist and the patients, and so a variety of
techniques are employed to improve cooperation during dental treatments. These methods include the
use of voice control, intimidation, restraints as well as sedation. Indications for use of sedation during
dental procedures include uncooperative patients, painful procedures and mentally handicapped
patient. Studies have shown that the use of sedation is effective in allaying anxiety during treatments,
thus leading to better cooperation from the patients. This study was designed to compare the
effectiveness of oral Midazolam and oral Ketamine as sedative agents for paediatric dental sedation
using the Ramsey Sedation Score and Frankl behaviour rating scale.
This prospective, double blind study was conducted among ASA I and II children between the ages
of 2–11 years, scheduled for elective dental extractions under sedation in the dental department of
Lagos State University Teaching Hospital (LASUTH) following ethical approval. Written informed
consent was obtained from the parents of all the patients.
A total of one hundred and four (104) patients were randomized into two groups of 52 patients each
by balloting using an opaque envelope method. The patients were fasted according to the ASA
guidelines and Group A patients received ketamine orally at the dose of 7.5 mg kg-1 body weight,
while group B patients received midazolam orally at dose of 0.75 mg kg-1. The intravenous forms of
both drugs were formulated in apple juice and administered orally. Extractions were carried out after
the patients achieved a Ramsay sedation score of 3. The behaviour of the patients during the procedure
were scored using the Frankl behaviour rating scale.
The mean time to achieve a Ramsay sedation scale score of 3 was significantly shorter for oral
ketamine (24.25 ± 5.55 minutes) than oral midazolam (28.79 ± 5.75 minutes); p<0.001. The median
score of the behaviour of patients using Frankl behaviour rating scale was 3 (range: 1.0-4.0) with oral
ketamine versus 3 (range: 2.0-4.0) for oral midazolam (p = 0.026). The mean time of response to
stimulus in the recovery room was similar between the two groups; oral midazolam (61.60 ± 11.46
minutes) versus oral ketamine (61.17 ± 14.11minutes); p=0.867. The mean discharge time was shorter
with oral midazolam (62.81 ± 13.64 minutes) than oral ketamine (78.46 ± 14.48 minutes); p<0.001.
Tolerance to local anaesthesia injection using the improvised Dental practitioner’s adequacy of
sedation assessment was better with ketamine 4.0(1.0-4.0) versus midazolam 3.0(1.0-4.0); p=0.012.
Among the dental surgeons, ketamine was acceptable to 90.4% compared to 98.1% in the midazolam
group (p=0.093). Both drugs were acceptable to the parents of the children with ketamine 94.2%
compared to midazolam 98.1% (p=0.309).
The mean heart rate during sedation was higher with ketamine (119.15 ± 20.64 bpm) than oral
midazolam (111.96 ± 14.27 bpm), p<0.041. Similarly, the mean mean arterial blood pressure (MAP)
during sedation was higher with ketamine (90.35 ± 14.05 mmHg) than oral midazolam (76.26 ± 11.49
mmHg), p<0.001. The mean oxygen saturation during sedation was similar between the 2 groups
(ketamine 99.42 ± 0.61% versus oral midazolam 99.37 ± 1.01%; p = 0.552) and midazolam caused a
transient depression of peripheral oxygen saturation to 92%. None of the children required
supplemental oxygen during the study.
Side effects were more prominent in the ketamine group with vomiting occurring in 11.5%,
nystagmus 26.9%, somnolence 28.8% and hyper-secretion in 17.3% of the patients.
In conclusion, this study observed that although oral ketamine had a faster onset than oral midazolam,
both medications were effective in achieving adequate sedation for dental extraction among the
children studied. However, side effects were more prominent with ketamine while recovery was faster
and smoother with midazolam making it a more suitable drug for day case procedures.
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THE EFFECTIVENESS OF EXTENDED MALLAMPATI TEST, HYOMENTAL DISTANCE RATIO AND NECK CIRCUMFERENCE – THYROMENTAL DISTANCE RATIO IN PREDICTING DIFFICULT INTUBATION
ABSTRACT
Laryngoscopy and intubation could become unexpectedly difficult and this is a
significant source of morbidity and mortality in anaesthetic practice. Pre-operative
airway assessment identifies those at risk of difficult laryngoscopy / intubation so as to
adopt safer alternative strategies at induction of anaesthesia. This study evaluated the
usefulness of Extended Mallampati Test (EMT), Hyomental distance ratio (HMDR) and
Neck-circumference-thyromental distance ratio (NCTMDR) in isolation and in
combinations in apparently normal patients and correlated these predictors with difficult
intubation using Intubation Difficulty Score.
Three hundred and fourteen ASA I & II adults scheduled for elective general
anaesthesia with tracheal intubation were randomly selected. During pre-operative
review, each patient’s weight (Wt), height (Ht), and neck circumference (NC) were
measured and noted. The EMT, HMDR and NC/TMDR were also assessed for each
patient and noted. EMT class ≥3, HMDR< 1.2 and NC/TMDR ≥ 5 were considered
predictive of difficult intubation. Intraoperatively, laryngoscopy was performed and the
Cormack and Lehane (CL) grading recorded for each patient. Grades 3 and 4 were
considered difficult intubation in the CL grading. The Intubation difficulty score (IDS)
was then calculated and noted. The sensitivity, specificity, positive predictive value
(PPV), negative predictive value (NPV) and false positive (FP) values for each airway
predictor in isolation and then in combinations were determined using a 2×2
contingency table.
Difficult intubation occurred in 5 out of 314 patients (1.6 %). The sensitivity,
specificity, positive predictive value (PPV), negative predictive value (NPV), false
positive and positive likelihood Ratio (PLR) for the three predictors were: EMT (50%,
99.7%, 80%, 98.7%, 1, 153.0), HMDR (4.05%, 99.1%, 60%, 77%, 2, 4.86), and
NC/TMDR (33.3%, 99.7%, 80%, 97.4%, 1, 100.7) respectively. Although their low
false positive values (1 for EMT, 2 for HMDR and 1 for NC/TMDR) and their areas
under the curves (AUC) of receiver operator characteristic curve (ROC) showed they
were all useful predictors, the EMT was the most accurate single predictor of difficult
intubation with an AUC of ROC of 0.878 (p- value 0.000). Furthermore, the Univariate
analyses also showed that though EMT, HMDR, and NC/TMDR were related to
difficult intubation, the relationship was significant only for EMT and NC/TMDR.
EMT however had the highest precision of this relationship with a kappa coefficient of
0.608 ( p-value < 0.001). The multivariate analysis odds ratios also estimated that EMT
predicted difficult intubation about 12 times better than HMDR and also about 1.5 times
better than NC/TMDR. Again, the combination of the anatomical distances (HMDR
plus NC/TMDR) was less accurate than EMT alone ( AUC of 0.797 as against 0.878
for EMT). Combining the EMT to the anatomical distances increased their accuracy
significantly at a p-value < 0.05. Both univariate analyses and Logistic regression
showed that at a p-value of < 0.05, there was no relationship between age, gender, body
mass index (BMI), neck circumference and difficult intubation.
In conclusion, EMT had the greatest predictive profile of all the three predictors
assessed singly. EMT improved the predictive values of the anatomical distances
(HMDR and NC/TMDR) in all the combinations. There was no relationship between
age, gender, BMI, neck circumference and difficult intubation
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USE OF MAGNESIUM SULPHATE AS ADJUVANT TO BUPIVACAINE FOR SPINAL ANAESTHESIA FOR MYOMECTOMIES AT NNAMDI AZIKIWE UNIVERSITY TEACHING HOSPITAL, NNEWI
ABSTRACT
BACKGROUND: Adequate analgesia following myomectomy decreases morbidity, hastens
ambulation and improves patient outcome. Central sensitization is an activity-dependent
increase in the excitability of spinal neurons. It is considered to be one of the mechanisms
implicated for development of pain. Intrathecal magnesium, an N-Methyl-D-Aspartate
receptor antagonist, inhibits central sensitization and has been shown to prolong analgesia
without significant side effects.
OBJECTIVES: To determine the effects of intrathecal magnesium sulphate in prolonging
the duration of spinal anaesthesia using hyperbaric bupivacaine for myomectomy.
METHODS: In this prospective, randomized, double-blinded study, 70 patients, aged 18-50
years of American Society of Anesthesiologists physical status I or II were randomly
assigned into two groups of 35 patients each to receive either intrathecal hyperbaric
bupivacaine 0.2mg/kg plus 50mg magnesium sulphate (group I) or intrathecal hyperbaric
bupivacaine 0.2mg/kg plus normal saline (group II). The outcome measures assessed were
the onset of sensory and motor bock, duration of sensory and motor block, duration of
analgesia, pain scores using Numerical Rating Scale, total postoperative analgesics consumed
in 24 hours, incidence of side effects and patients’ satisfaction.
RESULTS: Magnesium sulphate group had lower mean pain assessment scores throughout
the period of the study compared to the saline group (control group). The onset of sensory
block was prolonged in the magnesium sulphate group (3.42±0.08 minutes) compared to the
saline group (3.21±0.11 minutes) and it was statistically significant (p=0.001). The onset of
motor block was also prolonged in the magnesium sulphate group (7.75±0.76 minutes)
compared to the saline group (7.47±0.67 minutes) but was not statistically significant
(p=0.122). The duration of sensory block was prolonged in magnesium sulphate group
(144.38±9.14 minutes) compared to the saline group (124.69±9.67 minutes) and the observed
difference was statistically significant (p=0.001).The duration of motor block was also
prolonged in the magnesium sulphate group compared to the saline group (211.41±12.26
minutes vs 185.63±10.61 minutes) and the difference was statistically significant (p=0.001).
There was statistically significant difference between the duration of analgesia between the
magnesium sulphate group and saline group (253.50±5.90 min versus 199.00±4.19 minutes,
p= 0.001). The total amount of analgesics required 24 hour post-operatively was higher in the
saline group (443.43±29.25 mg) than in the magnesium group (374.22±19.56 mg) and the
difference was statistically significant (p=0.001).
Respiratory depression was not observed in any of the study groups. The incidence of
hypotension was 17.19% (11) in the magnesium sulphate group and 10.94% (7) in the saline
group but the difference was not statistically significant (p=0.266). Although, more patients
in the magnesium sulphate group (9.37%) had bradycardia compared to 6.25% among the
saline group, the observed difference was not statistically significant (p=0.491). One patient
vomited in the magnesium sulphate group, while two vomited in the saline group, (p=1.000).
No patient in the magnesium sulphate group experienced shivering while three patients
experienced shivering in the saline group and the difference was not statistically significant
(p=0.238).
The level of satisfaction between the two groups revealed that 21.2 % of the patients (7) in
the magnesium sulphate group reported their level of satisfaction as very satisfied compared
with 18.2% (6) in the saline group, (p=0.757). The proportion of patients that reported that
they were satisfied was 75.6 % (25) in the magnesium sulphate group while it was 69.7 %
(23) in the saline group, (p=0.069). The number of patients that reported being unsatisfied
was 3.0 % of the patients (1) in the magnesium sulphate group while it was 12.1 % (4) in the
saline group, (p= 0.852). The differences in the level of satisfaction between the two groups
were not statistically significant. There was no patient that reported not sure in either of the
groups.
CONCLUSION: This study therefore showed that the addition of 50mg magnesium sulphate to bupivacaine 0.2mg/kg for spinal anaesthesia resulted in superior quality of analgesia as
shown by lower mean pain assessment scores during the study compared with bupivacaine
alone, without increasing the incidence of side effects.
KEYWORDS: intrathecal, magnesium sulphate, myomectomy, spinal anaesthesia.
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INFORMATION:
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EFFICACY OF INTRAVENOUS PARACETAMOL INFUSION FOR PROLONGATION OF ANALGESIA UNDER SPINAL ANAESTHESIA FOR MYOMECTOMY
ABSTRACT
Acute pain is an unpleasant perioperative experience in patients undergoing
surgeries such as myomectomy under spinal anaesthesia. Combinations of various drugs
and techniques have been employed in prolonging the duration of analgesia with different
success rates. Paracetamol which is easily accessible with relatively mild side effects was
used for this study.
The aim of this study was to determine the effectiveness of intravenous
paracetamol infusion in prolonging analgesia under spinal anaesthesia when compared
with placebo.
The study was a prospective randomized double blind study with 126 patients of
ASA 1 and 11 aged 18 to 45 years undergoing elective myomectomy under spinal
anaesthesia. Patients were allocated to receive paracetamol (group P) or normal saline
(group N). Data collection with the aid of a proforma included age, height weight, ASA
physical status. Also documented was time to first analgesic demand, pain assessment
using the numerical rating scale and patient satisfaction with pain management.
The results were analyzed using Statistical Package for Social Sciences (SPSS)
version 17 and represented in tables and figures. The results showed that 37.1% of the
patients in group P needed additional analgesia between 90 and 150 minutes after spinal
anaesthesia when compared to 87.1% of patients in group N within the same period,
P<0.001, (Table III). Also 62.9% of patients in group P had pain score <4, six hours after
intravenous paracetamol infusion while none in group N had pain score <4 within the
same period after intravenous normal saline (Table 111). Mean time to first analgesic
demand was 4.75±1.59 hours and 2.23±0.15 hours for group P and group N respectively,
P<0.001), (Table IV), while the mean dose of additional analgesic was 11.81±2.50mcg
and 255.49±140.80mcg for group P and group N, respectively (Table V). The incident of
satisfaction with pain control was 0% poor, 24.2% good and 75.8% excellent in group P
when compared to group N with 62.9% poor, 37.1% good and 0% excellent (Table
V111).
In conclusion intravenous paracetamol infusion provided a better analgesia under
spinal anaesthesia as evidenced by increase in the time to first analgesic demand,
decreased Numerical Rating Scale (NRS) scores and it has a good margin of safety and
good patient satisfaction.
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Account Number: 3139283609
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FOR MORE INFORMATION, CALL:
08068231953 or 08168759420