Home > The Impact of a Multimodal Approach to Pre-Emptive Analgesia on Postoperative Pain and Analgesic Requirements for Patients Undergoing Orthopaedic Lower Limb Surgery at the Aga Khan University Hospital, Nairobi: A Single Blind Randomised Controlled Trial
The Impact of a Multimodal Approach to Pre-Emptive Analgesia on Postoperative Pain and Analgesic Requirements for Patients Undergoing Orthopaedic Lower Limb Surgery at the Aga Khan University Hospital, Nairobi: A Single Blind Randomised Controlled Trial
Study Objective: The aim of this study was to evaluate the postoperative morphine-sparing and pain reducing effects of a preemptive, multimodal, perioperative analgesic regimen incorporating the use of preincisional intrathecal blockade plus parenteral anti-inflammatory agents, in patients undergoing lower limb orthopaedic surgery. Study design: Prospective Single blinded Randomized Controlled Trial. Study setting: The Aga Khan Hospital, Nairobi, Kenya. Methods: 44 ASA physical status 1 and 2 patients undergoing lower limb orthopaedic surgery were randomly allocated into two groups of 22 patients each. Patients in the Intervention group were given a preincisional subarachnoid injection of 15mg hyperbaric Bupivacaine and 25mcg Fentanyl, plus, parenteral Paracetamol 20mg/kg and Diclofenac 1mg/kg. Patients in the Control group received a standardized general anaesthetic protocol consisting of Midazolam and Propofol, Oxygen, N2O, Isoflurane and cis-atracurium. Analgesia intraoperatively was maintained by remifentanil 0.1-0.3mcg/kg/min with Paracetamol 20mg/kg and Diclofenac 1mg/kg given at the end of surgery. PCA morphine 2mg/ml was instituted once the patient complained of pain. Intramuscular rescue doses of 10mg morphine were administered on patient request. Visual analog score (VAS) was used to assess pain over 48 hours, the cumulative PCA morphine dose and the total number of morphine rescue doses requested were calculated and compared for both groups. Results: 44 consecutive patients undergoing lower limb orthopaedic surgery completed the study (Intervention group, n=22; Control group n=22). The cumulative PCA morphine consumption at 2, 24 and 48 hours following patient first request for the control and intervention groups were 6.72 ± 6.33mg versus 5.72 ± 7.62mg ( P=0.6383), 19.682 ± 16.50mg versus 24.09 ± 17.83mg (P=0.3995), 34.409 ± 32.99mg versus 34.818 ± 23.11mg (P=0.9622) respectively. The mean difference in the number of Intramuscular 10mg morphine rescue doses requested by the patients between the control and intervention groups at 48 hours was 8.1818 ± 19.673 versus 3.2727 ± 9.228 (P=0.295). The median VAS at 2 hours was significantly lower in the intervention than control group, 5 ± 2.17 versus 3 ± 2.37 (P=0.0068). VAS at 6, 12, 24, 48 and 72 hours postoperatively were not significantly different between the two groups. The McGill pain questionnaire present pain intensity showed a significant difference between the control and intervention group, 2.31 ± 0.70 versus 1.81 ± 0.65 (P=0.00001). There was no significant difference in the pain rating index between the control and intervention group, 8.681 ± 2.46 versus 8.59 ± 2.30 (P= 0.8998). Conclusion: A non-statistically significant trend towards a
جو درِ یار تک نہیں پہنچا کیوں ہمارے دلِ حزیں کا حال لطفِ مے آج تک ارے ساقی یوں تو پہنچی ہوئی ہوں ہستی میں ایسا لگتا ہے کوئی نامہ بر ایسے ساغر کی ہوگی وقعت کیا کچھ دراڑیں ہیں کوچۂ دل میں اس کو بھی تم بھلا کہو گے عشق چل پڑا تھا ستارہ شام ڈھلے اس تباہی کے باوجود اب تک کئی محرومیاں مگر اکرام
کسی معیار تک نہیں پہنچا حلقۂ کار تک نہیں پہنچا ایک بیمار تک نہیں پہنچا پر ترے پیار تک نہیں پہنچا میرے غم خوار تک نہیں پہنچا جو طلب گار تک نہیں پہنچا ابھی مسمار تک نہیں پہنچا جو کہ آزار تک نہیں پہنچا جو شبِ تار تک نہیں پہنچا آدمی غار تک نہیں پہنچا کارِ بے کار تک نہیں پہنچا
Background of the Study: Sensory processing is the process in which all sensory stimuli integrate and enable person to respond according to the situation. There are number of sensory issues that either parents or teacher do not identify on early stages and various times it also cause behavioral issues or academic issues with in typical children too. The study aims to assess the sensory vulnerability of children with and without autism in the school environment and to identify the sensory issues.
Methodology: This was a cross-sectional study conducted in Karachi, Pakistan. Total 86 children recruited and divided into two groups included typical and atypical children. Using a standardized questionnaire-SPM (sensory processing measure) distributed in schools and completed by teachers.
Result: Autism affects both mainstream children and children with autism, with sensory process subscales showing significant differences p value (< .005) for t- test. Autism children have higher sensory process vulnerability, particularly in social participation and praxis variables, compared to mainstream children’s.
Conclusion: The study reveals that school initiates sensory stimuli, affecting children's vulnerability, even in special schools, despite providing structured environments for atypical children.
The study aimed to explore the impact of executive compensation and ownership concentration on firm performance. For this purpose relevant part of 524 annual reports of companies listed on KSE 100 are examine during the period from 2008 to 2014.
The regulatory framework (the Companies Ordinance 1984 and Code of Corporate Governance 2002) is very well articulated and covering all aspect of compensation and ownership concentration but the compliance of the law is not significant in Pakistan. Since many SROs are required to maintained functional website having information regarding company profile, Governance, investor relationship, media, election of directors, statement of compliance and financial statement. I am unable to access functional website of at least 15% of targeted sample (KSE 100 index).
Since majority of the companies in Pakistan are family centered that lead to ownership centering and these family owned companies are performing well therefore the owners does not open the slot for individual/institutional investors to avoid hostile takeover. CEO dominance is high under such conditions since the probability is higher that CEO is the owner of the company and he/she has the major role in BOD selection. This dominating position empowers him/her to restrict the monitoring role of the BOD and directors forced to ratify management decisions. CEO uses the same influence for setting up the compensation of top executives. This study also confirms that compensation has the positive relationship with firm performance where majority shareholding is with institutional investor but the same relationship become negative if ownership changes to non-institutional investors. Companies having financial business are subject to multiple legal / regulatory reviews in Pakistan. Studyreveals that legal regulation has impact on this relationship since I have observe that top executive compensation relationship with the firm performance is insignificant in companies having financial business in the comparison to the companies involve in non-financial business where I found some relationship between top executive compensation and firm performance.
Ownership structure in Pakistan also has the impact on relationship between ownership concentration and firm performance. Study observes the negative relationship between ownership concentration (represent by capital owned by top five shareholders) and firm performance. Market as whole observed an approximate reduction of .033% in AROA by Increase of 1% in ownership concentration. Institutional investors have external exposure and experience to manage companies therefore their ability to produce good results are higher. Study confirmed that ownership concentration have the positive relationship with firm performance where majority of the shareholding is with institutional investor but the same relationship become negative if ownership changes to non-institutional investors.
It noted that results of above mention variables are varying in different sectors. Impact of executive compensation and ownership concentration on firm performance is high in sectors like Services, Cement, Chemical, Fertilizer, Oil and Gas and other industry while sectors like Banks, Food, Power Generation and Distribution have limited impact and no impact have been noted in Non-banking Finance Companies and Textile.