Aim: To compare the outcome of subacromial ketorolac injection versus subacromial steroid injection in Shoulder Impingement Syndrome. Methodology: This randomized controlled trial was done at the Department of Orthopedics Unit II, Mayo Hospital, Lahore from 26th April 2018 to 25th October 2018. The sample size was 218patients 15 to 60 years of age with shoulder impingement syndrome, were included and patients with a fracture or rotator cuff tear who presented with weakness and muscle wasting, taking regular systemic NSAIDs or steroids, history ofgastrointestinal (GI) ulcers and bleeding disorderswereexcluded. Randomization was done by lottery method.Group A (ketorolac group) was given a single injection of 60 mg ketorolac mixed with 1 ml 2% lidocaine and Group B (steroid group) was given 40 mg methylprednisolone mixed with 1ml 2% lidocaine. All patients were followed up on 4th weeks. Results: Out of 218 patients, 117(53.67%) were males and 101(46.33%) were females with a male to female ratio of 1.2:1.The mean age of patients in group A was 39.09±9.90years and in group, B was 38.08±8.61years. The mean post-injection VAS score in group A was 2.80±0.94 and in a group, B was 4.20 ± 0.98 with a p-value of <0.001. The mean post-injection constant score in group A was 31.59±6.86 and in group, B was 41.31±4.56 with a p-value of <0.001. Conclusion: Sub-acromial ketorolac injection showeda better mean pain score and constant score than subacromial steroid injection in patients with shoulder impingement syndrome. Keywords: Shoulder Impingement Syndrome, subacromial ketorolac injection, subacromial steroid injection,

This prospective study was carried out in East Surgical unit, Mayo Hospital, Lahore for the period of two years from July 2001 to July 2002 on outpatient basis. Total of 50 patients aged between 20-50 years fulfilled the criteria of day case surgery i.e., health and social criteria (ASAI&II), only those were included in the study. The objectives were to evaluate the role of lateral sphicnterotomy under local anaesthesia as a day case surgery, considerable cost to patient and hospital, less morbidity and high patient acceptance. Thirty three patients (66%) were male and 17(34%) were female. Male to female ratio was about 2:1. Thirty nine patients (78%) presented with posterior anal fissure and 11 patients (12%) with anterior anal fissure. All patients operated under local anaesthesia as day case. Immediate relief from pain and painless first bowel movements was accomplished in 49(98%) of patients. No morbidity was observed. Postoperative complications were observed in 4 patients (8%) that resolved with conservative management. The patient acceptance was high (94%).

This prospective study was carried on 250 patients to study the complication and recurrence rate associated with Lichtenstien repair of inguinal hernia in our clinical and socioeconomic settings. The cost effectiveness and return to work after surgery were the other outcome measures. Two hundred and fifty patients underwent mesh repair of inguinal hernia at two different centers over a period of two years. All the patients were operated under local anesthesia. A bolus dose of preoperative antibiotic was given intravenously. The patients were followed up for two years and their post operative course was assessed according to a prescribed proforma. The rate of minor complications was in the range of 11.8%. The recurrence rate was 1.2%.There was minimal pain and the procedure was cost effective in terms of operative cost and less economic loss due to early return to work. It is concluded that Lichtenstien repair as a day case is safe and effective procedure to be performed by a trained general surgeon under local anesthesia. The infection rate and the recurrence rate are low. The compliance and acceptability of the patient and ease of carrying out the procedure under local anesthesia by surgeon is acceptable. In our view this type of hernial repair is an appropriate method in district hospital and tehsial headquarter hospitals where provision of anaesthesia facilities are yet to be fully developed and hospitals cater a major hernial load due to elderly patients with background of farming professions being admitted. The patient can be sent home on same day after surgery.

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