The aim of my study is to evaluate post-operative pain relief on patients who had hemorrhoidectomy. Materials and Methods: 300 patients who had hemorrhoidectomy were divided equally in to three groups, according to anesthesia type, group 1 (local anesthesia and sedation), while spinal anesthesia was group 2 and general anesthesia was considered to be group 3. Pain relief, post-operative complications, hospital staying time were measured and compared between the three groups. Period: Study was performed between Jan 2012 to Dec 2014. Results: The study showed that patients who had local anesthesia infiltration and sedation a significant decrease of post-operative total pain scores at 6/12/18/24 hours of more than 50%,200/240/300/320 out of 1000 points in group II as compared to 420/500/540/580,700/680/660/660 in 3rd groups respectively. The total postoperative analgesia doses in the 3 groups were 120:140:180 respectively, total hospital staying time were 130:210:260 days, headache in the ratio of 0:8:1, urine retention in 0:6:1 patients, nausea and vomiting in 0:1:5 patients were reduced by 30 %,. P-value < 0.05. On the other hand, spinal anesthesia which is group 2 showed slight decline of patients numbers who had respiratory symptoms, hypotension and urticarial.Conclusion: Post-operative pain, analgesia, total cost, hospital staying time, nausea and vomiting have been significantly reduced by local anesthesia infiltration compared to non-infiltrated groups while spinal anesthesia had a higher rate in post-operative urine retention, headache and hypotension compared to local anesthesia with sedation and general anesthesia. Respiratory symptoms, urticaria, were slightly reduced in local anesthesia with sedation compared to spinal and general anesthesia.

Background Severe traumatic brain injury (TBI) is one of the leading public health problems across the world. TBI is associated with high economic costs to the healthcare system specially in developing countries. Decompressive craniectomy is a procedure in which an area of the skull is removed to increase the volume of intracranial compartment. There are various techniques of decompressive craniectomy used that include subtemporal and circular decompression, and unilateral or bilateral frontotemporoparietal decompression. Objective The aim of this study was to compare the outcome of decompressive craniectomy for the management of severe TBI versus conservative management alone at the Department of Neurosurgery, Abbasi Shaheed Hospital, Karachi, Pakistan. Methods The study (randomized controlled trial) was conducted from February 1, 2014, till June 30, 2017. Results A total of 136 patients were included after following the inclusion criteria. They were randomly assigned to two groups, making it 68 patients in each study group. There were 89 males and 47 females. All the patients received standard care recommended by the Brain Trauma Foundation. The mortality rate observed at 6 months in decompressive craniectomy was 22.05%, while among conservative management group, it was 45.58%. Difference in mortality of both groups at 6 months was significant. Total 61.76% (42) of patients from decompressive craniectomy group had a favorable outcome (Glasgow outcome scale: 4–5) at 6 months. While among conservative management group, total 35.29% (24) had a favorable outcome (Glasgow outcome scale: 4–5). Difference in Glasgow outcome scale at 6 months of both groups was significant. Conclusion In conclusion, decompressive craniectomy is simple, safe, and better than conservative management alone.

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Objective The spinal column is one of the most prevalent regions for metastasis, with an increasing frequency of spinal metastases. Spinal cord metastatic tumor damages the vertebral body, weakens the spinal support, and exerts mass effect on the spinal cord. Overzealous surgical intervention does not provide any additional benefit in most of the spinal metastasis due to shorter life expectancy. The principal goal of this study is to analyze the outcome of various surgical treatments offered to patients with metastatic spinal cord compression (MSCC). Methods Retrospective cohort study including all patients that underwent surgical intervention for MSCC from March 2013 to March 2020. Results A total of 198 patients were included, 113 males and 85 females; the mean age was 62 years. The most common primary cancer was prostate (21.71%) followed by hematological (20.07%) and lung (16.66%). At 6-month postsurgery, 68.68% of patients were Frankel grade D or E (vs. 23.23% preoperatively), 16.6% were grade C (vs 57% preoperatively), and 14.64% were grade A or B (vs. 19.69% preoperatively). Pain on numeric rating scale was decreased from 6.38 ± 3.08 to 3.39 ± 0.73 at 24 hours postsurgery and 1.94 ± 0.67 at 6 months. Conclusion This study found that the majority of patients, undergoing minimally invasive spinal stabilization and decompression for metastatic spinal tumors, have better quality of life, analgesia, and mobility. In conclusion, treatment for spinal metastases should be individualized and a multidisciplinary approach is needed.

Background: The aim of my study is to evaluate post-operative pain reliefon patients who had hemorrhoidectomy. Materials and Methods: 300 patients who hadhemorrhoidectomy were divided equally in to three groups, according to anesthesia type,group 1 (local anesthesia and sedation), while spinal anesthesia was group 2 and generalanesthesia was considered to be group 3. Pain relief, post-operative complications, hospitalstaying time were measured and compared between the three groups. Period: Study wasperformed between Jan 2012 to Dec 2014. Results: The study showed that patients who hadlocal anesthesia infiltration and sedation a significant decrease of post-operative total painscores at 6/12/18/24 hours of more than 50%,200/240/300/320 out of 1000 points in group IIas compared to 420/500/540/580,700/680/660/660 in 3rd groups respectively. The total postoperativeanalgesia doses in the 3 groups were 120:140:180 respectively, total hospital stayingtime were 130:210:260 days, headache in the ratio of 0:8:1, urine retention in 0:6:1 patients,nausea and vomiting in 0:1:5 patients were reduced by 30 %,. P-value < 0.05. On the otherhand, spinal anesthesia which is group 2 showed slight decline of patients numbers who hadrespiratory symptoms, hypotension and urticarial.Conclusion: Post-operative pain, analgesia,total cost, hospital staying time, nausea and vomiting have been significantly reduced by localanesthesia infiltration compared to non-infiltrated groups while spinal anesthesia had a higherrate in post-operative urine retention, headache and hypotension compared to local anesthesiawith sedation and general anesthesia. Respiratory symptoms, urticaria, were slightly reduced inlocal anesthesia with sedation compared to spinal and general anesthesia.