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Home > A Randomised Controlled Trial Investigating the Effect of Adding Fentanyl to Low Dose Bupivacaine in Combined Spinal-Epidural Anaesthesia, Using Epidural Volume Extension Technique in Caesarean Section

A Randomised Controlled Trial Investigating the Effect of Adding Fentanyl to Low Dose Bupivacaine in Combined Spinal-Epidural Anaesthesia, Using Epidural Volume Extension Technique in Caesarean Section

Thesis Info

Author

Manyano, Mudola V.

Department

Anaesthesia (East Africa)

Program

MMed

Institute

Aga Khan University

Institute Type

Private

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2011

Thesis Completion Status

Completed

Subject

Medicine

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676728033498

Similar


Background: Epidural volume extension (EVE), is a technique whereby a small-dose intrathecal block is enhanced by an epidural injection of physiological saline. This epidural injection exerts a compression effect on the dura, which then leads to a cranial increase in sensory spread of the intrathecal local anaesthetic. The lower dose of local anaesthetic required in the EVE technique has made it possible to avoid the side effects of the conventional dose of local anaesthetic while still having the benefit of adequate anaesthesia. Several studies have been conducted in this area; these studies have either used or omitted fentanyl. The successful results demonstrated in these trials have been solely attributed to the EVE effect without taking into consideration the pharmacological effect of fentanyl on the total outcome. No study has been done to demonstrate the effect of fentanyl on the epidural volume extension block and whether adding or omitting it would make a difference on spinal block level and other characteristics. Objective: The study aims at determining the effect of fentanyl plus low dose bupivacaine on the spinal block level of combined spinal epidural (CSE) anaesthesia utilizing the Epidural Volume Extension technique. Study design: A randomised controlled trial Methods - Intervention: Forty four women scheduled for elective caesarean section were randomized to 2 groups. One group got intrathecal bupivacaine with fentanyl followed by Epidural Volume Extension with physiological saline (Fentanyl group). The second group got intrathecal bupivacaine without fentanyl followed by epidural volume extension with physiological saline (No-fentanyl group). - Outcome measures: The outcome measures for this study were, the maximum sensory level which was measured by loss of sensation to temperature using a cold spirit swab, the motor block which was assessed using the Bromage score and the time to first request to analgesia taken as the time the patient first needed to use their PCA device or epidural supplementation intraoperatively. Results: The sensory block level after epidural volume extension increased in both arms. The increase was more in the intervention arm (Fentanyl group) than in the control arm (Nofentanyl group). This increase was however not statistically significant P=0.19. The sensory block level after epidural volume extension in the fentanyl group was 4 levels higher than the initial intrathecal block, while in the control arm the change was 3 levels higher than the than the initial intrathecal block. The time to first request of analgesia was shorter in the no-fentanyl
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مولانا احمد رضا بجنوری

حضرت مولانا احمد رضا بجنوری کی وفات حسرت آیات
دینی ومذہبی اورعلمی دنیاکاایک اورچراغ بجھ گیا ۔حضرت مولانا احمد رضا بجنوری ۹۴ سال کی عمر میں مختصر سی علالت کے بعد انتقال فرماگئے ۔اناﷲ وانا الیہ راجعون ۔
۲۲؍رمضان المبارک ۱۴۱۸ھ مطابق ۲۲؍ جنوری ۱۹۹۸ء کوحضرت مولانا احمد رضا بجنوری کاانتقال ہوا۔جیسے ہی یہ خبر دفتر برہان میں پہنچی سب ہی رنج وغم میں ڈوب گئے۔کیونکہ حضرت مولانا احمد رضا بجنوری کاتعلق، واسطہ اور رابطہ ادارہ ندوۃ المصنفین اوررسالہ برہان سے روز اول ہی سے رہا۔ادارہ کے بانی مفکر ملت حضرت مفتی عتیق الرحمن عثمانیؒ سے حضرت مولانا کابھائیوں سے بھی بڑھ کرقلبی تعلق رہا۔ایک توہم سبق ہونے کی وجہ سے اوردوسرے استاد محترم حضرت مولانا انور شاہ کشمیری ؒ کے چونکہ مولانا احمد رضا داماد تھے اس لیے استاد کے داماد ظاہر ہے بھائی اور بہنوئی ٹھہرے۔
اسی وجہ سے حضرت مفتی صاحبؒ مولانا احمد رضا کو بہت ہی چاہتے تھے ان سے قلبی محبت اور لگاؤ رکھتے تھے۔اوراسی رشتہ سے حضرت مولانااحمد رضا بھی حضرت مفتی صاحبؒ کو بڑے بھائی کی حیثیت سے سمجھتے تھے۔ہرمعاملے میں ان کی رہنمائی کواپنے لیے ضروری سمجھتے تھے۔
حضرت مولانا احمد رضا بجنوری عربی زبان کے زبردست عالم تھے۔عربی پرخدا داد عبور حاصل تھا اوراسی طرح اردوزبان پربھی انہیں ملکہ حاصل تھا۔ان کی عربی زبان اوراردو زبان میں زبردست تصانیف ہیں۔ان کی مشہور ومعروف کتاب ’انوار الباری‘ (کئی ضخیم جلدوں میں) اعلیٰ درجہ کی علمی کتابوں میں شمار ہوتی ہے۔ انہوں نے بلندپایہ تصانیف قلم بندکی ہیں۔جسے زبردست علمی ذخیروں میں شمار کیا جاتا ہے۔
اﷲ تعالیٰ کروٹ کروٹ جنت نصیب کرے۔ آمین۔ادارہ ندوۃ المصنفین اوررسالہ برہان حضرت مولانا احمدرضا بجنوری کے انتقال پُرملال پر اظہار تعزیت کرتا ہے اور بارگاہ عالی میں دعا گو ہے کہ حضرت مولانااحمد رضا بجنوری کی مغفرت فرمائے اور ہم سب کو صبر...

ماحولیاتی آلودگی اور اس کا سدباب: سیرت نبویﷺکی روشنی میں ایک تحقیقی جائزہ

Today, the whole world is facing the dangerious issues of environmental pollution. There is a lot of piles of garbage, plastic bags and waste are found in common routes and streets, the use of bacterial and antiseptic chemicals, smoking as well as the excessives use of machinery causes the abundance of smoke and due to the noise of vehicles, rugs, motorcycles, factories and airplanes, our daily pollution is increasing daily. As a result, many problems including various types of illness and seasonal variations are becoming a major challenge for today's modern era. In order to deal with it, it is important for us to study and follow the instructions of the Prophet (PBUH). Prophet (PBUH) has taken important measures to protect environmental pollution. He has prescribed some precautionary measures to prevent the spreading of dirt in society and keeping the environment clean to avert the soil pollution. For the purpose of aviation of air pollution, the prophet has ordered to populate it with the livestock andplantation. To cope with water pollution, it was emphasized to keep water clean and cleaness of air from odor and dirt. In this modern era, prevention of environmental pollution without following these instructions is impossible. This article has invesitaged on prevention of enviromental pollution and cleanliness of enviroment in the light of Sīrah.

Efficacy and Impact of Gm Bt Cotton in Ecosystem

Use of genomic technology for engineering crops to combat various stresses has been witnessed in early 1980s. For example, “Bt”, coined with genes (Cry1Ac, Cry2Ab, etc.)— provide protection to lepidopteron insect pests, excised from a soil bacterium, were introduced in multiple crops including corn, cotton, soybean, rice, potato and canola. In Pakistan, work on introduction of Cry1Ac gene from a source cotton material (containing Cry1Ac gene) to local cotton cultivars through backcrossing breeding scheme has been started at the start of this 21st century, resulted in the development of more than 20 Btcotton varieties. Since the gene was new to our environment, was the compelling factor for studying various aspects including yield performance, expression of Bt gene under various environmental conditions and its impact on NTOs. In the present study, we tested the efficacy and the impact of Bt-cotton in Pakistani environment, which paved the way for approval of Bt-cotton varieties. Performance of 20 Bt-cotton genotypes (called as IR-cotton genotypes in the dissertation) along with 5 non-Bt conventional counterparts were evaluated in 10 different locations all over the Pakistan, of which most commonly, IR-cotton out yielded their non-IR cotton genotypes. On average, IR-cotton genotypes-cultivars produced almost 24.8% more seed cotton yield (SCY) than their non-IR counterparts for four years (2005-08) at all experimental sites and the yield advantage ranged from 21 to 30%. Likewise, mean values for the number of boll plant-1 were also found substantially higher (19-25%) in IR-cotton than that of non-IR conventional cultivars at 10 different locations. Furthermore, average boll weight was also significantly higher in IR-cotton (8.81%) than the conventional cultivars, which is primarily because of the selections made for high boll weight in developing IR-cotton. However, this advantage was not as higher as observed in case of SCY and number of bolls plant-1. IR-NIBGE-3701 was identified as the most adapted genotype, and recommended for cultivation. The present study was also aimed to examine the impact of drought on the expression of Cry1Ac gene in a set of 25 cotton genotypes-cultivars including five conventional counterparts. This study was conducted during the three normal cotton growing seasons (2005-2007). These genotypes-cultivars were grown under well-watered and water-limited conditions in NIBGE cotton field. Seed cotton yield and its components were markedly affected under the water-limited regime. Mean reduction in SCY due to water deficit was 19, 22 and 27% in 2005, 2006 and 2007, respectively. Moreover, genotypes-cultivars were also substantially differed for SCY ranging from 12.65 to 35% during the three consecutive years under stress conditions. Seed cotton yield was sustainability affected under waterlimited regime mainly due to fluctuation in number of bolls plant-1 rather than average boll weight. Similarly, the water stress significantly depressed the expression of Bt gene, i.e. ranging from 19 to 32% as cumulative for three years (2005-2007). Remarkably, no change was observed towards the efficacy of transgene against the Helicoverpa armigera. Another important abiotic factor is the problem of elevated temperature during the cotton growing season in Pakistan, and it significantly depresses the cotton production. Thus we tested the expression of Cry1Ac gene under normal and high temperature regimes for three years. In total 20 IR-cotton genotypes were exposed to high temperature (37±2oC) under glasshouse conditions, and the Bt expression level along with the efficacy was measured at 35, 60, 90 and 120 DAS. Our results revealed that after exposing cotton plants to high temperature, expression of Cry protein was decreased from 3.28-41.65% at different time intervals without effecting the biological activity (efficacy toward controlling the Helicoverpa armigera). However, the response of Cry protein expression under high temperature was significant among the genotypes-cultivars studied at different growth stages. Genotypic variation regarding the expression levels of Cry1Ac in normal as well as CLCuD infected cotton plants were found in the studies conducted for three years (2006-2008). The disease significantly reduced the expression of Cry1Ac, fluctuating between 26% (IRNIBGE- 3701 and IR-NIBGE-2422) to 64% (IR-NIBGE-2457) with a mean reduction of 47% between the IR and non-IR-cotton genotypes-cultivars. Though we have found significant reduction in expression of Cry 1Ac gene between the asymptomatic and symptomatic cotton plants but we could not establish any correlation between the disease incidence percentage and relative reduction in expression of Cry1Ac gene. The potential impact of IR-cotton on non-target organisms (NTOs) have also been studied independently for three and four consecutive years for soil microorganisms and non-target insects (jassids, thrips and whitefly), respectively. Statistically insignificant results were found for soil microorganisms (bacteria including actinomycetes and fungi) collected from IR or non-IR cotton. However, significant variations were observed for plant growth stages (30, 60, 90, 120 and 150 DAS) for microbial population. Similarly potential impact on NTOs (Jassid, whitefly and thrips) was demonstrated significance among the genotypescultivars, but non significant differences were observed for the Bt trait in four years of experimentation. Findings of the present studies paved the way for the approval of Bt-cotton varieties in Pakistan. Cotton cultivars IR-NIBGE-3701, IR-NIBGE-1524 and IR-NIBGE-901 identified from these experiments helped in sustaining cotton production in Pakistan. All these efforts have been admired by the Govt of Pakistan (bestowed Pride of Performance by the President of Pakistan on August 14, 2011) and International Cotton Community. These findings suggest that the introduction of Bt-cotton in the farming system of Pakistan is the best alternative to conventional non-Bt cotton which be useful in increasing the cotton production in Pakistan. The less capital intensive nature of this system may be particularly interesting for resource poor cotton farming communities and also to the ecologists. It is extremely important to enhance protection against the bollworm complex by introducing new genes in cotton as the single gene based protection can be broken down at any time. These efforts together would be another step in the door towards sustaining cotton production in the country till 2020.