No abstract

Background: Patients after Cesarean Section go through post operative pain. Most of this pain is experienced after the abdominal wall incision. Transversus abdominis plan (TAP) block as part of multimodal analgesia is a novel approach for patients delivered by cesarean section (CS). This technique (TAP block) lends itself particularly well to resource-poor settings as it does not require a nervestimulator. The aim of this study was to evaluate the efficacy of transversus abdominis plane (TAP) block when it is used as part of multimodal analgesia on obstetric patients after Cesarean Section. Methods: Institution based prospective cohort study design was conducted on patients, who have Cesarean Section from February to May, 2015. All patients operated under spinal anesthesia for cesarean delivery were included. Patients divided into TAP block (n=20) and controls (n=20). The TAP block group was given bilateral 20 ml of 0.25% bupivacaine at the end of surgery. Postoperative pain was assessed within the first 24 hours i.e. at 2 hours, 4 hours, 6 hours, 12 hours, and 24 hours using 100 mm long visual analogue scale (VAS), total analgesic consumption and time for the first analgesic request. Result: There was reduction of VAS scores within the first 24 hours after cesarean section in TAP block group compared with the control group. VAS scores as median(IQR) at 2 hours 0.

Background: Post-Dural Puncture Headache (PDPH) is a common problem after a deliberate puncture of the dura-arachnoid for the purposes of diagnosis, therapy, spinal anesthesia, or unintentionally during epidural procedures. It is a clinically main complication which affects the daily life of patients with marked restriction of their physical activities. Spinal anesthesia is the frequent anesthetic procedure for obstetric patients which identified as cause for PDPH. The aim of the study was to assess the prevalence and associated risk factors of PDPH after Cesarean Section (CS) delivery under spinal anesthesia.Method:An institution based cross sectional study design was conducted on all eligible obstetric patients who came for operation under spinal anesthesia from September, 2015 to January,2016. The data collection method was including chart review and patient follow up for three days of post operative period.Results: 107/251 (42.6 %) patients developed PDPH. Among those patiens with PDPH big needle sizes (AOR=8.6; 95% CI: 0.06-0.46) and repeated number of attempts (AOR= 4.54; 95% CI: 0.52 -39.14), were found to be significantly associated with the dependent variable of PDPH on the multi variate logistic regression. Conclusion and recommendation:In this study, we showed the prevalence of PDPH was higher, 107/251 (42.6 %) compared with other literatures. The study also showed that big spinal needles and repeated number of attempts were the independent associated risk factors for PDPH in Felege Hiwot Referral Hospital, Bahir Dar, Ethiopia. The higher magnitude of PDPH has to be reduced by avoiding use of big needles, and the repeated dura puncture.

Background: Thyroidectomy is associated with mild to moderate type of pain. The employment of regional anesthesia for thyroid surgery remains controversial for some studies. We tested the hypothesis that multiple injection of Bilateral Superficial Cervical Plexus Block (BSCPB) reduced pain scores, opioid consumption and prolongs time of analgesic request after thyroid surgery. Methods: of 45 patients, 40 completed the study. They were allocated in to two groups: the Bilaterela Superficial Cervical Plexus Block (BSCPB) and the control group. The outcome measures were the severity of pain measured on Visual Analogue pain rating Scale (VAS), total opioid consumption, and first analgesic request time during the first postoperative 24 hours. Results: The main outcomes recorded during the first 24 hours were Visual Analogue scale pain score (VAS, 0-10), total opioid consumption and the first analgesic request time. There were VAS scores at rest with median (IQR) in mm 9.00(5.00-16.00) vs. 15.00(10.00-22.00), p < 0.013 and at swallowing with mean ± SD in mm 11.00 ± 8.52 vs 28.70 ± 7.40 p < 0.001for the BSCPB and control group after 24 hours of surgery respectively. It was also showed a statistically significant (p < 0.005) difference observations between the groups throughout the whole period of visit. Twenty four hours after surgery, total tramadol consumption was significantly reduced in cases (BSCPB) and control groups as 550 vs 2350 milligram p < 0.05, respectively. After surgery, time for first analgesic request was significantly prolonged in BSCPB (560.00 vs 26.00, p < 0.001) minutes. Conclusion and recommendation: A multiple injection of BSCPB provided superior analgesia for elective thyroid surgery done under general anaesthesia. We recommend BSCPB to be included as part of multimodal analgesia before intubation for thyroidectomy.

Background: Several additives have been suggested to enhance analgesic effect of local anesthetic agents to decrease the adverse effects and increase the degree of satisfaction.Objective: To assess postoperative analgesic effect of intrathecal neostigmine added to bupivacaine in comparison with bupivacaine alone for adult patients undergoing Lower limb Orthopedic Surgery at Tikur Anbessa specialized Hospital, Addis Ababa, Ethiopia, from January 1 to February 30, 2017 G.C. Methods:This institutional based prospective observational cohort study was conducted among 60 adult patients scheduled for elective lower limb orthopedic surgery under spinal anesthesia and grouped in to bupivacaine group based on independent decision of responsible anesthetist. Patient's vital signs were taken intraoperativley. Postoperatively duration & consumption of analgesia, first analgesia request as well as severity of pain using 100mm visual analogue scale score were assessed over 24hrs. Normality of the data was checked using Shapiro-Wilk test and analyzed using student t test for normal distributed data and chi-square test for categorical data. Non-parametric data was analyzed using Mann-Whitney U test with 95% CI and p-value less than 0.05 is considered as statistically significant. Results:Bupivacaine neostigmine group (BN, n=30) compared with bupivacaine only group (BS, n=30) which was presented by mean±standard deviation, time of the first analgesic request in neostigmine and bupivacaine group was (377.60±9.14) and (230.07±17.11) in minute respectively, p<0.001.Morever total amount of tramadol consumption was also significantly different between the two groups that was presented by median (inter quartile range),which was 50(50) mg in neostigmine group vs. 100 (50) mg in bupivacaine group. The visual analogue scale score also reduced at1hr, 2hrs, 3hrs, 4hrs, 5hrs and 6hrs in neostigmine group. Conclusion and Recommendation:Addition of 25mcg intrathecal neostigmine as an adjuvant to 15 mg bupivacaine for elective lower limb orthopedic surgery increased first analgesia request time, reduced postoperative analgesia consumption and with minimal hemodynamic changes and side effects. We recommend that the use of intrathecal neostigmine combined with bupivacaine for lower limb surgery in our setup.