A single-blind, randomized prospective trial was performed at a university hospital to determine if preoperative relaxation training will decrease pain and narcotic demand postoperatively. A convenience sample of 49 patients undergoing lumbar and cervical spine surgery was randomized to receive instruction on relaxation techniques or routine preoperative information before surgery. Pain score and narcotic demand in the first 48 hours after surgery were the primary outcomes. Pain scores were higher in the relaxation (4.8 ± 1.7) versus the standard preparation group (3.9 ± 1.7) on postoperative day one (POD) 1, but lower on POD 2 (3.9 ± 1.9 vs 4.1 ± 1.9), whereas narcotic use (milligrams of IV morphine per hour) was higher in the relaxation group on POD 1 (1.14 ± 0.94 vs 0.54 ± 0.55) and POD 2 (0.86 ± 0.73 vs 0.50 ± 0.61). The differences were significant for narcotic demand (P = 0.01) but not for pain (P = 0.94). In conclusion, our results could not support the use of relaxation training for reducing postoperative pain and narcotic demand in this selected surgical population.

Objective: To assess renal function in combat patients at the time of arrival from Balochistan in Accident & Emergency (A&E) of an ‘A’ Class Military Hospital. Study Design: Retrospective observational study with analysis to find correlation between measurable variables and glomerular filtration rate.  Place and Duration Of Study:  Combined Military Hospital Malir Cantonment, Karachi, from October 2015 to October 2018. Material and Methods: All patients with major injuries (New Injury Severity Score NISS ≥16) were included in the study to assess kidney function by calculating their estimated glomerular filtration rate (eGFR) using serum creatinine. Correlation was calculated between eGFR and other variables which were pulse, mean arterial pressure, temperature and haemoglobin. Results: 75 patients were brought to A&E. 14 (18.66%) were brought in dead. There were 44 (58.6%) gunshot wounds, 14 (18.6%) blast injuries and 17 (22.6%) accidents post ambush attack. 26 (34.66%) were included in the study, with NISS ≥16. All patients were male with mean age 29.73 ± 5.08. 20 (77%) patients were fluid resuscitated in pre-hospital setting whereas 6 (23%) were not. Statistically significant correlations were found among eGFR and pulse rate, body temperature, mean arterial pressure, hemoglobin and NISS. 6 out of 26 patients not resuscitated in pre-hospital setting had a median eGFR of 53.5, as compared to median eGFR of 70 in 20 patients who were resuscitated before evacuation to CMH Malir, in the field medical units. Conclusion: Fluid resuscitation in the field lowers the possibility of renal dysfunction.

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