Introduction: Sciatica is an important medical problem with socioeconomic impact; its effective management remains a challenge. Approximately 80% of the total population experiences low back pain at some point in their lives which may be associated with sciatica. As it is more common in adult working group, the pain caused by sciatica can incapacitate a person fromdoing his or her normal work. So the goal of our treatment is not to cure anatomic abnormalities but rather to reduce pain, which allows the patient to engage in early rehabilitation and return to a more normal lifestyle.Methods: Fifty patients were initially included in the study and all patients received three injection of 4ml methyle prednisolone acetate (160 mg) and 6 ml of Normal saline that is of total volume 10 ml.at an interval of 48 hours. Among 50 study patients, five patients dropped out in subsequent follow-up. So only forty-five patients were analyzed for final results.Results: The mean age of the patient was 37.53 years, majority between 30-56 years. Female who were involved in household activities dominated the study group. Comparing the mean (SD) VAS score on the day of presentation 70.00 (16.78) and on 35th day 17.89 (25.23) so it was found to be statistically significant (P<0.001). None of the patients in the study had motor weakness and none of them developed serious complications. But 12 (26.7%) patients developed transient headache after the procedure.Conclusions: As the goal of our treatment was symptomatic pain relief, most of the patient’s pain improved at 2 weeks after the steroid injection with no severe complication. This was short term study with encouraging results, but larger scale and longer period of follow ups required for better results.

Introducti on: Improvements in anesthesia, pain management, the evoluti on of minimally invasive surgery and changing atti tudes to recovery aft er surgery have all promoted to the expansion of scope of day care surgery. The use of stapled haemorrhoidectomy is an accepted treatment modality for prolapsing hemorrhoids of varying degree. To evaluate the outcome of pati ents undergoing stapled hemorrhoidectomy in the early postoperati ve period with special focus on pain intensity, requirement of analgesic and its feasibility as a day care procedure.Method: Interventi onal, clinical, hospital based study carried out at Shree Birendra Hospital between November 2010 and May 2011. The feasibility of discharging pati ents on the day of Stapled Hemorrhoidectomy was evaluated.Results: Of the eleven (n=11) pati ents selected for daycare Stapled Hemorrhoidectomy ten pati ents (~90%) could be discharged aft er six hours of observati on. Conclusion:Stapled Hemorrhoidectomy is a safe and easily mastered technique with superior results in the immediate/ early postoperati ve period. The initi al cost of the stapling device is the main concern but social and economic savings related to a faster recovery may off set the initi al cost especially when it is performed on a day care basis.

DOI: http://dx.doi.org/10.3126/njog.v5i2.5083NJOG 2010 Nov-Dec; 5(2): 55-56

Pheochromocytoma is rare, accounting for less than 0.1 % of hypertensive population. In this report, wedescribe a 40-year-old male a diagnosed case of pheochromocytoma who underwent adrenalectomyunder general anaesthesia with epidural analgesia. The patient was adequately prepared with alphaadrenergic blockers. Intraoperative course was stormy but was managed with antihypertensives,inotropes and intravenous fluid. The patient was electively ventilated overnight and had an uncomplicatedrecovery.Pheochromocytoma is a rare medical condition and an anaesthesiologist comes across it only a few timesin his or her practice. Therefore there is a limited exposure in management. Furthermore hemodynamicinstability encountered intra and postoperatively itself is a challenge. Hence management of a case ofpheochromocytoma demands a meticulous preoperative preparation, advanced monitoring devices andgood interdepartment coordination preferably in a tertiary medical center for a favourable outcome.Key words: Haemodynamic instability; inotropes; pheochromocytoma; Sodium Nitroprusside.DOI:  10.3126/mjsbh.v9i1.3486Medical Journal of Shree Birendra Hospital Vol.9(1) 2010 19-23

Introduction: Diagnostic colonoscopies are generally done in OPD basis and requires sedation and analgesia to relieve both anxiety and pain. Propofol and midazolam combination is used worldwide and allows rapid and profound sedation with quick recovery. But data on combined sedation with midazolam, pentazocine and propofol are not found. So this study was conducted to test this combination for day care surgery. Methods: Prospectively, 242 colonoscopy procedures who had received combined sedation with midazolam, pentazocine and propofol were analysed. Midazolam and Pentazocine were given intravenously as a single dose of 2 mg and 15 mg respectively. 20 mg of Propofol was given bolus, than 10 mg top up titrating sedation till procedure is nished. Pulse, Non Invasive Blood pressure and oxygen saturation were recorded. Patients' genders, ages, weight, length of procedure and the need of total received Propofol for complete sedation in mg were recorded. Movement during procedure, the time of recovery and any complications were also recorded. Patients were also asked whether they had any memories of procedure. Results: Lower dose of propofol is required to produce adequate aesthesia. ere are no complication and vitals were stable including oxygen Saturation. ere was quicker recovery as all patients responds on verbal command just a er the procedure and no patient had memories of the procedure. All patients safely discharged within one hour. Conclusions: e combination is safe and comfortable for patients undergoing diagnostic colonoscopy to produce adequate anaesthesia without any signi cant complications.