ABSTRACT… Objectives:The aim of our study is to provide a comparison between levobupivacaine and bupivacaine administered intra articulary in the knee joint during arthroplasty procedures, and compare the postoperative analgesic effects. Method: Study Design: Randomized control trial. Period: One year duration from March 2015 to March 2016. Setting: Tertiary care centre in Karachi, Pakistan. The study population consisted of n= 50 patients belonging to ASA class II and III, who were scheduled to undergo TKA (total knee arthroplasty). The patient population was divided into two groups, group A consisted of all the patients who received bupivacaine, and group B consisted of all the patients who received levobupivacaine. All the patients were between the ages of 18 and 70 years, and had normal joint mobility. After explaining the procedure and taking due informed consent, the patients were informed about the use of the visual analog scale for pain and the patients controlled epidural anesthesia (PCEA). Readings of echocardiograph, blood pressure and pulse oximetry, sensory and motor characteristics of the established block, side effects, number of boluses and doses of PCEA, total amount of pain relief medications utilized over the period, VAS scores and time of mobilization and discharge from the hospital were also noted in a pre-designed. Statistical analysis was done using SPSS version 23. Results: The study population consisted of n= 50 patients. The VAS scores at were found to be lower in the bupivacaine group at 4,8,12 and 24 hours and VAS scores at 48 hour were lower in levobupivacaine group having a p value of less than 0.05, but the VAS scores were similar at the 0,2 and 72 hours in both the groups. The post-operative analgesic requirement was similar for both groups. The sensation of pain at the time of post-operative physiotherapy measure with the VAS score, was also similar in the two groups having a p value of less than 0.05. Similar results were found between the time of discharge and time of mobility, having a p value of less than 0.05. Conclusion: The use of multimodal analgesia with the administration of intra articular local anesthetics combined with PCEA is a very effective method to provide post-operative pain relief in patients undergoing total knee arthroplasty. Key words:Intra articular administration, knee arthroplasty, levobupivacaine, bupivacaine, post-operative analgesia, patient controlled epidural analgesia.

Objectives: In this study we aim to study the efficacy of Ramosetron and Palonosetron in preventing post-operative nausea and vomiting in high risk patients. Study Design: A randomized controlled trial. Setting: A Large Tertiary Care Centre in Karachi. Period: 9 months from January 2017 to September 2017. Method: N=81 participants took part in the study. The patient population was divided into three groups.. Patients belonging to group A received Palonosetron 0.075mg mixed with normal saline in a mixture of 3ml, prior to induction, and received 3ml of normal saline half an hour prior to the end of the procedure. Patients in group B received 3ml of normal saline prior to induction and a mixture of 0.3mg of Ramosetron mixed with normal saline as 3ml half an hour before end of procedure. In group C patients received normal saline 3ml both before induction and half an hour prior to end of surgery. Results: The patient demographics were similar in all the groups and no significant difference was found. The incidence of post-operative nausea and vomiting during 2 hours post operatively was 41.97%, the incidence of nausea at 2 hours was in group A= 33.33%, in group B= 29.62%, in group C= 62.96% respectively, having a p value of 0.014 refer to table 2. After 48 hours of surgery the overall incidence of vomiting in the groups was not significant having a p value of 0.428 and an incidence of 6.172%. Conclusion: Palonosetron and Ramosetron are equally effective in prevention of post-operative nausea and vomiting in high risk patients undergoing laparoscopic gynecological procedures.

The aim of our study which is to compare total intravenous anesthesia with target controlled infusion using the drugs Propofol and remifenatnil with the techniques of volatile induction maintenance anesthesia using sevoflurane and sufentanil in patients undergoing laparoscopic cholecystectomy procedure, at a tertiary care hospital in Karachi, Pakistan. Study Design: The type of study is a randomized control trial, conducted for a period of 8 months Period: from June 2015 to January 2016 Setting: at a tertiary care hospital in Karachi Pakistan. Method: The patient population consisted of n=100 patients belonging to the ASA class I and II and undergoing laparoscopic cholecystectomy procedure at our institute. The patients were divided into two groups group A consisted of all those patients who underwent total intravenous anesthesia and group B consisted of patients who underwent volatile induction maintenance anesthesia. Appropriate blinding measures were taken for those who were involved in the post-operative care of the patients, and the patients themselves. During the procedure routine monitoring was done, data was recorded in a pre-designed proforma. Patients were analyzed in the post-operative period for side effects and pain levels. Statistical analysis was done using SPSS version 23, a p value of less than 0.05 was considered to be statistically significant. Results: The patient population consisted of n= 100 patients divided into two groups. No statistically significant difference was found between the demographic variables of the patients of both groups (age, weight, baseline values of blood pressure, heart rate, time duration of surgery and anesthesia). The time for the loss of corneal reflex was longer in the group A (109 +/-90) as compared to group B (45 +/-10) having a p value of less than 0.001. However the time for opening of the eyes and the duration of post anesthesia care unit was shorter in group A (420 +/-130 seconds for eye opening and 45 +/-15 min for PACU) and in group B (484 +/-116 seconds for eye opening and 53 +/-25 mins for PACU) having p values of 0.006 (eye opening) and 0.017 (PACU) respectively. In group A n= 44 (88%) of the patients required rescue analgesia, and in group B n= 36 (72%) of the patients required it, having a p value of 0.013 respectively. The need for the use of ephedrine and atropine in the pre and port operative period was similar in both the groups. Conclusion: According to the results of our study we found that each method of anesthesia has its own advantages and disadvantages and the anesthetist present should weigh the risks and benefits for each patient individually, and use the most beneficial method of administration of anesthesia in the patient undergoing laparoscopic cholecystectomy procedure, accordingly.