Background: The cardiac operative procedure has a significant relationship with acute onset of pain. After cardiac surgery, pain has been managed with the help of opiate analgesics. Objective: To analyze the adverse effects of postoperative multimodal analgesia after cardiac surgery concerning the physical and specific biochemical parameters of undergoing surgery patients. Materials & Methods: It was a single-center, prospective study where patients were approached on the day before their cardiac surgery. A total of 120 post-cardiac operative surgery patients at Khwaja Yunus Ali Medical College Hospital, Sirajganj were included for this study purpose. Results: In first group, three types of analgesia were used in 60 patients and in second group, five types of analgesia were used in another 60 patients. About 76.7% were male and mean age was 45.73 (± 11.3) years. Fentanyl was used for all patients followed by paracetamol (96.7%), diclofenac (83.3%), tramadol (16.7%), and pethidine (3.3%). Drug-induced nausea and vomiting were found in 76.7%and 66.7% patients respectively followed by drowsiness (36.7%) and vertigo (20.0%). Conclusion: In patients undergoing cardiac surgery, a multimodal regimen offered better analgesia. Furthermore, nausea and vomiting complaints were reduced significantly in the multimodal group. KYAMC Journal Vol. 13, No. 02, July 2022: 94-97

Background: Transversus Abdominis Plane (TAP) block is a regional anaesthetic technique used for postoperative pain management following abdominal surgery. Local anesthetics like bupivacaine can be used in this block and it can be performed in various approaches. Among them ultrasound-guided lateral and posterior approaches are popular. Objective: Aim of this study is to compare the effectiveness of lateral and posterior approaches of ultrasound-guided TAP block using bupivacaine in the management of post-operative pain after total abdominal hysterectomy under subarachnoid anesthesia. Materials and Methods: This randomized clinical trial was carried out in the Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU) Dhaka. Total 90 patients were scheduled for elective total abdominal hysterectomy and assigned into two equal groups, group A and group B received ultrasound guided TAP block in lateral approach and in posterior approach respectively. Then patients were observed for pain intensity at rest and during deep breath by visual analog scale (VAS), after 1 hour, 2 hours, 4 hours, 6 hours, 12 hours and 24 hours of TAP block. The time of first analgesic demand was noted. Statistical analyses of the results were obtained by using window based computer software devised with Statistical Packages for Social Sciences (SPSS-22). Results: The mean pain intensity at rest and during deep breath was statistically significant (p<0.05) at 4, 6, 12 and 24 hours after TAP between two groups. The mean duration of first analgesic demand was 5.04±0.54 hours in group A and 6.59±0.69 hours in group B was statistically significant (p<0.05) between two groups. Conclusion: TAP block in posterior approach provided considerably effective postoperative analgesia in first 24 hours than lateral approach after total abdominal hysterectomy. KYAMC Journal Vol. 13, No. 02, July 2022: 66-71

Background: General anaesthesia is used for breast cancer surgery. The downside of generalanaesthesia includes inadequate pain control and a high incidence of nausea and vomiting. Generalanaesthesia with intravenous dexmedetomidine or intercostal nerve block reduce the incidence ofpostoperative pain. Objective: To evaluate the effectiveness of intravenous dexmedetomidine compared to intercostal nerveblocks in patients undergoing simple mastectomy with axillary dissection under general anaesthesia.Methods:It was a single-blinded prospective randomized comparative study. This study was conductedat the Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh MujibMedical University (BSMMU), Dhaka from March 2018 to March 2019. A total of 60 patients sufferingfrom breast cancer admitted in the Department of General Surgery of BSMMU Dhaka and scheduledfor simple mastectomy with axillary dissection, were enrolled in this study. Results: Age ,height andweight were almost identical between two groups. Duration of anaesthesia and surgery were almostsimilar between two groups. The mean heart rate, systolic blood pressure, diastolic blood pressure ,mean arterial pressure did not significantly fluctuate in subsequent baseline follow up and 15 minuteand at 160 minutes parameters were almost similar within two groups.Mean time to achieve adequateAldrete recovery score after extubation was almost similar between two groups. Postoperative sedationlevel was also similar between two groups. Majorty of the surgeon were satisfied about anaesthesiatechnique in both group A and group B. Mean time of rescue analgesic requirement in postoperativeperiod was satistically significant (p<0.05) between two group but it was clinically less significant(groupA= 112 minutes and groupB=141minutes. Conclusion: Intravenous dexmedetomidine may be an alternative to intercostal nerve blocks inpatients undergoing simple mastectomy with axillary dissection under general anaesthesia as itprovided stable intraoperative haemodynamics, reduced blood loss and analgesic requirement, smoothrecovery, postoperative sedation level and surgeon satisfaction as well as intercostal nerve blocks. JBSA 2021; 34 (2) : 24-35