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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

Thesis Info

Author

Bugo, John M.

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

1676728071385

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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
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صوتیات کا اجمالی جائزہ

صوتیات کا اجمالی جائزہ
زبان اللہ تعالیٰ کی ایک عظیم نعمت ہے۔ یہ اظہار کا ذریعہ ہے۔ صوتیات وہ علم ہے جو ہمیں زبان کی آوازوں اور ان کی جان کاری میں نہ صرف مدد فراہم کرتا ہے، بل کہ اس کے لیے اصول بھی مرتب کرتا ہے۔ صوتیات میں زبان کی آوازوں کےپیداہونے کے طریقے اور ان کی صحیح درجہ بندی کا مطالعہ کیاجاتا ہے۔ صوتیات لسانیات کی اہم شاخ ہے۔ بعض علمائے لسانیات کے بقول صوتیات کے بغیر لسانیات نا کافی ہے۔ صوتیات کا کام زبان کی آوازوں کو دریافت کرنا، اس کو صحیح رسم الخط فراہم کرنا، جن زبانوں کے پاس رسم الخط نہیں ہے انہیں رسم الخط فراہم کرنا اور الفاظ کی درست ادائیگی میں معاونت ہے۔ ہر زبان میں عہد کے ساتھ ساتھ تبدیلیاں رونماہوتی رہتی ہیں۔کچھ الفاظ متروک ہوتےہیں، کچھ کا املا بدل جاتا ہے اور کچھ قواعد واصول بھی بدلتے رہتےہیں۔ صوتیات کسی بھی زبان کا منظم علامتی اور تصوراتی نظام ہوتا ہے۔ انسانی ذہن بے شمار آوازیں پیدا کرنے کی خُداداد صلاحیت رکھتا ہے۔ انسانی منہ سے اَن گنت آوازیں نکلتی ہیں لیکن صوتیات میں صرف بامعنی آوازوں کا مطالعہ کیا جاتا ہے۔ زمان ومکان کے حالات کے مطابق زبان میں پایا جانے والا تغیر وتبدل اس کی صوتی ہیئت میں بھی تبدیلیاں لاتا ہے۔
صوتیات کی تعریف
بقول پروفیسر اقتدار حسین:
’’زبان کی آوازوں کے سائینٹی فک یامنظم طور سے مطالعے کو صوتیات کہتے ہیں۔‘‘۲۹؎
جیسا کہ لسانیات کے باب میں بتایا گیا ہے کہ یہ ایک سائنس ہے، اسی طرح صوتیات بھی ایک سائنس ہے۔ ڈاکٹر اقتدار حسین نے اسے زبان کے سائنیٹی فک مطالعے سے تعبیر کیا ہے۔ لہٰذا ہم کہہ سکتے ہیں کہ ماہر صوتیات ایسا سائنس دان ہوتا ہے جو زبان کی تمام آوازوں کو سمجھنے، ان میں فرق کرنے اور ان کا...

Globalization’s Grotesque Face: The Economic Oppression of Women Agriculture Workers in Pakistan

Pakistan’s economy is firmly linked to agriculture and food production. Since the inception of the country, no real land reforms have been undertaken, and the rural elite remains a major force in controlling agricultural land. At the same time, since the 1990s the country has also followed a neoliberal agenda, through the International Monetary Fund led structural adjustment programs, and then later after Pakistan’s entrance in the World Trade Organisation in1995. The trade liberalisation agenda of the advanced capitalist countries, especially the United States, have been consistently implemented in the country. In this context, it is clear that at least two different levels of political and economic forces are present in the rural economy. There is also no doubt that Pakistan also has a strong patriarchal society, which governs the social and economic norms of society.

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Acute renal colic is probably one of the most excruciatingly painful event a person can endure. [1]. Though this is typical of urinary tract calculi, it’s important to note that non-calculus and non-genitourinary conditions can present in a similar manner. Unenhanced helical CT (CT KUB), originally described by Smith et al [2] in 1995, is one single radiological test that has proven successful in the valuation of patients presenting with renal colic. This technique has been shown to be more accurate compared to abdominal radiography [3,4], ultrasound and has replaced excretory urography in the detection of urinary tract calculi in many situations [5]. Currently CT KUB has become the clear test of choice for imaging patients with suspected renal colic for a variety of reasons including its speed, non utilization of contrast, high accuracy for diagnosis or exclusion of stone and determination of stone burden, size and location; assessment of obstructive effects of the stone; identification of significant alternative and additional diagnoses; utility in guiding appropriate patient management [6, 7&8]. Therefore it has gained widespread acceptance among radiologists, emergency department physicians, and urologists. However because of the associated radiation dose, various protocols have been studied in an attempt to reduce this dose and found to be equally accurate [6, 7, 8 &9]. The purpose of this study is therefore to evaluate the diagnostic performance of a low radiation protocol in the patient population referred to our department, by comparing CT KUB findings and clinical outcome(s).