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Original Research Article
The Efficacy of Transverse Abdominal Plane Block with Bupivacaine Combined with Dexamethasone for the Management of Post-Caesarean Pain
I. Guibla, S. I. S. Traoré, K. B. Ki, S. C. Ilboudo, B. I. Bado, C. A. Ouattara, B. E. Komboigo, J. N. Savadogo, D. A. Sawadogo, D. A. Somé, Z. C. Méda, I. A. Traoré
EAS J Anesthesiol Crit Care; 2024, 6(2): 12-19
DOI: 10.36349/easjacc.2024.v06i02.001
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44 Downloads | March 6, 2024
ABSTRACT
Introduction: Caesarean section (CS) is a commonly performed major surgical procedure that causes significant postoperative pain. The objective of this study was to evaluate the efficacy of the transverse abdominal plane block (TAPB) in the management of post-caesarean pain at the Souro Sanou Teaching Hospital (CHUSS) of Bobo Dioulasso. Methodology: This was a single blind randomised clinical trial. One hundred patients admitted for CS under spinal anaesthesia were randomised into two groups using the sealed envelope method. The intrathecal morphine (ITM) group received 100 µg morphine intrathecally at induction and the TAPB group a bilateral TAPB at the end of the caesarean section with 20 ml of 0.25% bupivacaine and 4 mg dexamethasone in the same syringe on each side. The proportion of mild pain, numeric rating scale (NRS) < 3 on mobilisation at 24 hours post-caesarean was the primary outcome. Results: The 2 groups were comparable for socio-demographic and clinical characteristics. The mean age of the patients was 28.14 ± 6.34 years and 29.08 ± 5.58 years (p=0.43). At rest at 24 hours post-op, the proportion of NRS < 3 was 100% for the TAPB group and 88% for the ITM group (p=0.49). On mobilisation at 24 hours post-op, 96% of patients in the TAPB group and 74% in the ITM group (p=0.002) had a NRS < 3. At rest at 48 hours post-op, it was 100% for the TAPB group and 88% for the ITM group (p=0.027). On mobilisation at 48 hours post-op, it was 94% for the TAPB group and 70% for the ITM group (p=0.002). Postoperative nausea and vomiting (PONV) were present in 50% of patients in the ITM group and 6% in the TAPB group (p<0.001). Conclusion: TAPB significantly reduced pain scores on mobilisation in the post-caesarean period with a significant reduction in PONV.
Original Research Article
ABSTRACT
Background: The milieu of intensive care units (ICU), the meticulous management of critically ill patients, especially in terms of nutrition, is paramount. Malnutrition poses a serious threat, emphasizing the necessity to assess and enhance current nutritional care practices. Objective: This cross-sectional study aimed to evaluate the adequacy of nutritional care for ICU patients at Rajshahi Medical College Hospital and multiple multi-central base hospitals between 2020 and 2022. Methods: Data were collected from patient records, ICU nursing documentation, and direct patient or family interviews. A total of 100 ICU patients were included through a multistage cluster sampling design. Patient demographics, including age and gender, were analyzed concerning nutritional care practices. Results: The study found that the mean patient age was 54.8 ± 19.97 years, with 45.3% over 60. Male patients predominated, but females were notably older. Nutritional care practices in the ICU varied, with initial feeding starting on the second ICU Day for 66% of patients, mainly via enteral (57.2%) or oral (37%) routes. Patients achieved only 59.2% ± 37.78 of prescribed calories and 55.5% ± 30.04 of required protein, with adequate intake for only 16.2% and 10.7% of patients, respectively. Nutritional care practices varied, with most patients receiving nutrition support, yet inadequate energy and protein intake were common. This underscores the need for personalized ICU nutrition care. Conclusion: This study emphasizes the need for tailored nutritional care in the ICU, considering the diverse age groups and gender differences among patients. Further research and targeted interventions are warranted to optimize nutritional support for critically ill patients.
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Creutzfeldt Jakob Disease is a rare and fatal neurodegenerative disorder characterized by rapidly worsening dementia, myoclonic jerks and akinetic mutism. It accounts for more than 90% of all human prion diseases. Over 90% of patients progress from normal function to death in under a year. There is no definitive treatment and it must be distinguished from other causes of rapidly progressive dementia such as viral encephalitis, autoimmune and paraneoplastic encephalitis which will respond to appropriate therapy. In the following 2 cases, we describe patients with presentation of rapidly progressive dementia which was finally diagnosed as Probable sporadic CJD. It is essential to make early diagnosis as it will allow patient and family to understand the course of disease and prognosis.
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IgG4 Related Disease (IgG4 RD) is a comparatively new multisystem disorder associated with elevated levels of IgG4. It includes a number of disorders which were previously thought to be idiopathic or autoimmune. This is a rare condition and can affect any organ system in the body with IgG4 Related pachymeningitis having even lesser incidence. In this case report we present a patient who had chronic low back ache, who on evaluation was found to have a mass compressing on the spinal cord at the thoracic level, requiring surgical decompression. Biopsy and immunological testing were suggestive of IgG4 related pachymeningitis. We describe the diagnosis, medical management, and follow up of this patient, with discussion on how timely diagnosis and management will help in preventing further episodes and help in recovery. This case reiterates about medical conditions presenting as tumor mimics.
Original Research Article
The Bilateral Tap-Block Ultrasound-Guided in Laparoscopic Abdominal Surgery: Evaluation of a Curare-Free Anaesthetic Protocol
M. Diedhiou, N. Sarr, A. Ndong, F. G. Niang, E. B. Ba, D. Barboza, J. N. Tendeng, M. L. Diao, I. Konaté, M. M. Traoré, M. L. Fall
EAS J Anesthesiol Crit Care; 2023, 5(6): 112-119
DOI: 10.36349/easjacc.2023.v05i06.004
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171 Downloads | Nov. 20, 2023
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Introduction: The transverse abdominal plane block or TAP block consists of injecting a local anaesthetic between the internal oblique and transverse muscles. Its contribution to muscle relaxation during laparoscopic surgery has been little studied. Material and Method: We carried out a 2-years prospective, descriptive and analytical randomised study blinded to the surgeon conducted in the operating theatre of the Saint Louis Regional Hospital Centre. Patients were randomised into two groups: those who received vecuronium after rapid sequence induction (group V) and those who received bilateral TAP block without curares (group T). Anamnestic, clinical, anaesthetic, surgical and evolutionary aspects were collected and analysed. The main evaluation criteria were: pneumoperitoneum pressure, exhaled CO2, respiratory motor pressure and surgeon satisfaction scale. Results: We collected 61 patients admitted for laparoscopic abdominal surgery. The mean age was 32.9 years with a standard deviation of 14.5. Appendicitis was the indication in 55% of cases. The Propofol-celocurine-TAP-block anaesthetic protocol was used in 25 patients, i.e. in 41% of cases, and 59% of patients had undergone a conventional induction using vecuronium. The mean pressure of the pneumoperitoneum was 11.3 mmHg for the conventional induction group and 12.6 mmHg for the TAP-block group. The mean respiratory motor pressures were 12 cmH2O for the conventional induction group and 13.7 cmH2O for the TAP-block group. The mean value of exhaled CO2 was 37.5 mmHg. Fentanyl reinjections were more frequent in the conventional induction group in 55.6% of cases. The mean VAS at 6 hours post-op was 4.5 for the conventional induction group and 3 for the TAP-block group. Discussion/Conclusion: The ultrasound-guided trans-abdominal-pelvic block remains an effective, durable and reproducible technique. Its advantages in terms of postoperative analgesia are well known. In addition, its selective effects on muscle ......
Original Research Article
ABSTRACT
Aim of the study: To study the risk factors and the clinical consequences of perioperative hypothermia in pediatric surgery. Patients and Method: It was an observational and descriptive prospective study conducted over a period of two (2) months from December 10th, 2021 to February 10th, 2022. Were inclueded in the study children from 0 to 15 years old who were done general anesthesia with tracheal intubation in a elective surgery that lasted 30mn at least. The variables studied were: age, gender, American Society of Anesthesiologists (ASA) status, type of surgery, the means used for prevention, perioperative incidents, intraoperative transfusion, patient’s temperature before induction and during surgery until extubation, duration of the surgery, duration of anesthesia. Results: During the period of our study, 89 patients were collected. The average age was 4,79 ± 3,53 years with extremes of 14 days and 15 years. The most represented age group was that of 1 month to 5 years with 61% of cases. Male gender represented 66.29% of cases, a sex ratio of 1.96. Perioperative hypothermia was noted in 64.04% of the patients, it was moderate in 95% of cases and severe in 3% of cases; all the age groups were concerned but newborns were the most susceptible. The room temperature fluctuated around an average of 27 ± 2,7°C with extremes of 24.6°C and 30°C. Digestive surgery predominated with a frequency of 57.30%. ASA I was the most represented class in 65% of cases. Risk factors were age, the type of surgery, a high ASA level, duration of the surgery and blood transfusion. All the patients who received transfusion presented hypothermia. The most common consequences of perioperative hypothermia were wake-up delay in 35% and bradycardia. Conclusion: Perioperative hypothermia is very common in pediatric surgery. Then, it should be prevented effectively to avoid its complications.
Original Research Article
ABSTRACT
Aim of the study: To assess the knowledge and attitudes of anesthesia staff on the management of pain in the hospitals of Niamey. Patients an method: This was a multicenter descriptive cross-sectional study carried out in five hospitals in Niamey (Republic of Niger) from July 3rd to December 3rd, 2021. Were been included in the study, all the anesthesia staff who agreed to answer the questionnaire. The variables studied were: age, gender, seniority, sector of activity and qualification, definition of pain, different types of pain, the impact of pain on the body, tools used for assessment of pain, difference between acute and chronic pain, knowledge about analgesics, the practical attitudes of pain management. The data were intered and processed with Epi info 7.2 software and the Microsoft Office 2019 pack. Results: Our study concerned 106 agents from the anesthesia and resuscitation department of the hospitals that served as our study framework. There is a female predominance of 55.42% with a sex ratio of 0.80. The 45-54 age group was the most represented with 40.07% of cases. The average age of respondents was 44.95 ± 8.9 years. Anesthesia nurses were the most represented with 90.36%. The operating theatre unit was the most represented sector of activity with 85.54%. All the respondents knew the definition of pain. The different types of pains were known by 45.78% of respondents. The most used pain scales were visual analog scale (VAS) and verbal descriptor scale (VDS) respectively in 53.01 % and 12.05 % of cases. Tramadol and paracetamol were the mostly used analgesics respectively in 98.80 % and 97.59%. Intravenous morphine titration was known to 67.47% of the respondents. Only 18.07% of the respondents benefited from a training on the management of pain. Conclusion: The knowledge and attitudes of anesthetists on pain deserve to be updated through theorical and practical training to improve the management of pain in our hospitals.