Objective: To compare between the efficacy of Ketorolac and Paracetamol in the management of post-operative pain following elective cardiac surgery. Study Design: Randomized (single-blind) Control Trial (RCT NCT05361824.) Place and Duration of Study: This study was conducted in the Surgical Intensive Care Unit (SICU) at the National Institute of Cardiovascular Diseases Hospital, Karachi Pakistan, From 1st Jan to 30th Jun 2021. Methodology: Randomization of 60 patients undergoing elective cardiac surgery into either Paracetamol (30 control patients) or Ketorolac (30 treatment patients) was done.In addition, to a low dose, short duration background infusion of Nalbuphine, the control group was administered. Injection Paracetamol 1gm every six-hours. Whereas the treatment group was administered injection Ketorolac 30mg every eight-hours. Assessment of pain was done at 6, 12, 18 and 24 hours post-extubation, using a Visual analog scale (VAS). For the purpose of this study, a score of 4 or less was taken as a cut-off for adequate pain control. Results: VAS score was significantly lower in Ketorolac group as compared to the Paracetamol group at all four-time points with an average rating of 3.2±1.9 vs. 5.3±1.7; p<0.001, 3.5±1.5 vs. 5±1.7; p<0.001, 3.3±1 vs. 5.0±1.4; p<0.001, and 3.0±1.4 vs. 4.3±1.6; p<0.001 at 6, 12, 18, and 24 hours respectively. The total dose of Nalbuphine administered (infusion + bolus doses) over 48 hours post-operatively was 15.3±5.2 vs 25.7±6.8 ml; p<0.001 in the Ketorolac and Paracetamol groups, respectively. Conclusion: The use of Ketorolac in conjunction with Nalbuphine gives better control over post-operative pain in elective cardiac surgeries than Paracetamol and Nalbuphine.

Objective: To find out the effect of Dexmedetomidine infusion on renal function in patients undergoing Coronary Artery Bypass Graft (CABG) surgery. Study Design: Randomized control trial (RCT- NCT05375188). Place and Duration of Study: The research was conducted in the Department of Anesthesia, National Institute of Cardiovascular Diseases Karachi Pakistan, from Jun to Sep 2021. Methodology: 60 patients were allocated randomly into two groups. In Group-D, Dexmetedomidine was given as an infusion of 0.4 μg/kg/h from induction of anesthesia for 24 hours. In Group-C, patients were receiving an equal volume of normal saline. The primary outcome of the study was Serum Creatinine (mg/dl) which was measured 24 hours before the surgery as baseline and then 24 hours and 48 hours after surgery. Results: In Group-C Serum Creatinine was found to be 0.96 +/- 0.21mg/dl at baseline, 1.02 +/- 0.35 mg/dl after 24 hours and 1.38 +/- 0.47 mg/dl after 48 hours of surgery. In Group-D Serum Creatinine was found to be 0.76 +/- 0.12 mg/dl at baseline,0.85 +/- 0.17 mg/dl after 24 hours and 0.82+/- 0.24 mg/dl after 48 hours of surgery. p-value was found to be <0.001 after 48hours of surgery. Conclusion: Dexmetedomidine infusion significantly reduced incidence of acute kidney injury in patients undergoing coronary artery bypass graft surgery.