Methods: Included analysis of 300 patients. Patients of all age groups and gender were included in this analysis. We reviewed their clinical records regarding age, gender, incidence and type of pneumothorax, pneumothorax episodes and its causes. Diagnosis of pneumothorax was based on clinical examination and plain chest X-rays of patients. Results: Pneumothorax occurred only in 26 (8.7%) patients. Out of these 26 patients, there were 3 (1.0%) patients in whom spontaneous pneumothorax occurred and in remaining 23 (7.7%) patients pneumothorax was iatrogenic in nature. There was significantly higher rate of mortality in patients who developed pneumothorax 38.46%versus 3.2% in patients without pneumothorax (p-value <0.001). Duration of ICU stay was also significantly prolonged in pneumothorax patients 11.4 days versus only 6.2 days in patients without pneumothorax (p-value <0.001). Patients with iatrogenic pneumothorax, mortality occurred in 5 (83.3%) patients in whom pneumothorax occurred due to mechanical ventilation, 1 (33.3%) in patients with central venous catheter insertion, 2 (22.3%) in patients with pericardiocentesis and 2 (40.0%) in patients with thoracentesis. Conclusion: Pneumothorax is associated with a very high mortality and increased length of ICU stay. Mortality rate is higher in pneumothorax due to mechanical ventilation (barotrauma) as compared to other procedure related pneumothoraxes.

Objectives: To determine the efficacy of co-administration of magnesiumsulphate (MgSO4) with bupivacaine in enhancing the analgesic efficacy of Transversusabdominus plane block (TAP block) in patients undergoing total abdominal hysterectomy.Study Design: Randomized clinical single blinded trial. Setting: Department of Anesthesia,Nishtar Medical University/Hospital Multan. Period: 07 months from March 2017 to October2018. Methods: We included female patients who presented with uterine or ovarian cancer andplanned for total abdominal hysterectomy. In group B patients (n=30) TAP block was givenusing 0.25% bupivacaine (20 ml). In group M patients (n=30), 19.4 ml 0.25% bupivacaine plus0.60 ml Mg sulphate. Mean arterial blood pressure, heart rate, VAS pain score and time of1st rescue analgesia and total dose of rescue analgesia was noted in all patients. For dataanalysis we used independent sample t-test (Mann-Whitney U test for skewed data) to comparequantitative variables. Chi-square test we used for comparison of ASA status. P-value < 0.05was taken as significant difference. Results: Mean VAS pain score after 1 hour was 3.27+1.70in group B and 2.23+1.35 in group M (p-value 0.012), after 2 hours mean VAS pain score was4.03+2.10 in group B and 2.47+1.25 in group M (p-value 0.001), after 6 hours mean VAS scorewas 4.53+2.62 in group B and 3.27+1.36 in group M (p-value 0.02). Mean VAS pain score after12 and 24 hour of shifting the patient in recovery room was no significantly different between thegroups (p-value 0.55 & 0.08 resp.). Mean time of 1st rescue analgesia was 7.53+4.92 hours ingroup B versus 13.96+2.25 hours in group M. Conclusion: Administration of 200 mg of MGSO4with bupivacaine for TAP block significantly improves the duration of analgesia and reduces therequirement of rescue analgesics in patients undergoing total abdominal hysterectomy.