A Study on Epidural Tramadol Compared with Epidural Fentanyl Combined with Low Dose Bupivacaine for the Control of Metastatic Cancer Pain

Background: Despite advances in the knowledge of pathophysiology of pain and its management, patients continue to suffer from pain in many terminal stage cancer. Tramadol hydrochloride is a weak opioid with analgesic properties, and can be tried for cancer pain management. Objectives: This study was performed to find out the efficacy of the analgesic property of Tramadol through epidural route in cancer patients as an combination with low dose(.125%) Bupivacaine and to compare with Fentanyl, a μ opioid agonist. Methods: 50 Cancer patients with or without previous pain management were randomly allocated to one of the two study regime- Group-A (tramadol 50 mg) and Group-B (Fentanyl 50 mgm) in combination with .125% Bupivacaine. Drugs were administered epidurally 6 hourly, 8 hourly and 12 hourly respectively for the 1st, 2nd and 3rd day. Low dose bupivacaine was added to both groups to enhance quality. Pain scores, blood pressure, respiratory rate, heart rate, side effects and patients' satisfaction score was recorded 6 hourly for 72 hrs. The data yielded from this study were compiled and analyzed by unpaired and paired ‘t' test with 95% confidence limit. A value of P< 0.05 was considered to be significant. ÷ square test was done for some of the data. Results: Pain scores were significantly decreased in both the groups but were not significantly different. The incidence of side effects including nausea and vomiting was found in both the groups and was not significantly different between the two groups. Conclusion: The use of epidural Tramadol in selected cancer pain patients (especially pain in lower abdomen and lower back) may be very useful and is comparable to opioid in certain situations. Key words: Metastatic cancer pain; Epidural tramadol. DOI: 10.3329/bsmmuj.v2i2.4760 BSMMU J 2009; 2(2): 66-7

Arthritis as a presentation of acute leukemia

A 14 year old boy presented with 3 months history of low back pain as well as pain and swelling of both knee joints. The pain was inflammatory in nature. He was thoroughly evaluated but no underlying cause was detected. However, the boy was treated with NSAIDs and sulphasalazine. A few weeks later he developed anemia and took the blood transfusion. Then he developed fever and the joint pain re-appeared. On examination, the patient was found moderately anemic, positive bony tenderness and splenomegaly. Musculoskeletal examination revealed right knee joint effusion. The investigation revealed pancytopenia. Bone marrow morphology and immunophenotyping revealed acute lymphoblastic leukemia. We treated the patient according to modified UKALL-2003 protocol and patient condition improved and arthritis disappeared

Haemoglobin E/Beta Thalassaemia- A Study in BSMMU

Background: Thalassaemias and haemoglobinopathies have been found sporadically in every ethnic group and geographic region, they occur with particularly high frequency from the shores of the Mediterranean and Africa through the Middle East, the Indian subcontinent, Burma and Southeast Asia. Objective: The study was designed to find out the incidence of HbE/beta thalassaemia in BSMMU. Method: A total of 700 patients suspected to have been suffering from haemolytic anaemia were included in the study. Patients having evidence of haemolysis in peripheral blood film were selected for reticulocyte count and haemoglobin electrophoresis in cellulose acetate membrane at pH 8.6. Result: The study group of 700 patients underwent Hb-electrophoresis of which only 52 (7.4%) cases were diagnosed as HbE/beta thalassaemia. Out of 52 cases, 34 (65.4%) patients were found symptomatic and the remaining 18 (34.6%) patients were asymptomatic. Out of 34 symptomatic cases of HbE/beta thalassaemia, only 14 cases needed blood transfusion. Among the 14 patients, only 8 patients needed more than 10 units of transfusion and 6 patients needed frequent transfusion that is two units of blood in every month. Conclusion: It is clearly evident from the present and other studied so far carried out in this Indian subcontinent and South-East Asia that hereditary haemolytic anaemia due to globin chain defects are quite common in this region, especially in Bangladesh and are responsible for considerable morbidity and mortality. Key words: Thalassaemia; Haemoglobinopathies; HbE/beta thalassemia. DOI: 10.3329/bsmmuj.v2i2.4762 BSMMU J 2009; 2(2): 78-8

Anaesthetic complications in CO2 laser in ENT surgery

The word laser is an acronym for light amplificationby stimulated emission of radiation and lasertechnology is one consequence of Novel Prize winningin quantum mechanics, which is most important in20th century physical sciences. The rapidadvancement of this technology in ENT surgery hasbeen accompanied by complications, making itimperative that anaesthesiologists as well as ENTsurgeons understand the potential threat to theirpatients and themselves and be preparing to respondproperly. CO2 Laser surgery in ENT is one of thosesurgical procedures in which the surgical risk isminimal while the anaesthetic risk is great. This isbecause of the general problems presented bylaryngeal, pharyngeal and tracheal surgeries combinedwith unique specific problems of the lase

Frequency of consanguineous marriage among the thalassaemia major patients in Bangabandhu Sheikh Mujib Medical University

Thalassaemia is a commonly occurring hereditary disorder. There is a high prevalence of thalassaemia disease in South-East Asia as well as Bangladesh. It is an autosomal recessive disorder, so consanguineous marriage is a very important factor for this disease. Mutated beta globin gene of haemoglobin from both parents is responsible for this disease to occur. But when the number of thalassaemia carriers is miserably high, then only avoidance of consanguineous marriage can’t prevent the birth of children with thalassaemia major. So, this cross sectional study was conducted among 120 diagnosed (by haemoglobin electrophoresis or high performance liquid chromatography) thalassaemia major patients in the Department of Haematology, Bangabandhu Sheikh Mujib Medical University, Dhaka from July 2019 to May 2020. History from each patient was taken and blood samples were collected from their parents to confirm carrier state by haemoglobin electrophoresis. Blood samples were also collected from patients and their parents toperform complete blood count and peripheral Blood Film. This study showed the mean age of the participants was 15±9.34 and 73 (60.8%) patients were male and 47 (39.2%) were female. About, 71% of the study population lived in urban area, 81 (67%) patients were transfusion dependent thalassaemia patients. 15% thalas- saemia major patients had the history of consanguinity of their parents. Among the parents of the thalassaemia major patients, 62.5% were Beta thalassaemia trait (heterozygous state), 25.83% parents were Hb E trait ( heterozygous state), 7.08% parents were suffering from Beta Thalassaemia Major(homozygous state) and 11 (4.58%) parents were suffering from Hb E/Beta Thalassaemia which is a compound heterozygous state. Though consanguinity is a very influential factor, but the most important causative factor is the presence of high number of thalassaemia carrier in the population. So, it’s a burning issue for the nation to perform a routine carrier screening for all rather than focusing on consanguinity only, to lessen the burden of thalassaemia disease in Bangladesh. BSMMU J 2022; 15(1): 25-2

Research priorities in regional anaesthesia: an international Delphi study

Background: Regional anaesthesia use is growing worldwide, and there is an increasing emphasis on research in regional anaesthesia to improve patient outcomes. However, priorities for future study remain unclear. We therefore conducted an international research prioritisation exercise, setting the agenda for future investigators and funding bodies. Methods: We invited members of specialist regional anaesthesia societies from six continents to propose research questions that they felt were unanswered. These were consolidated into representative indicative questions, and a literature review was undertaken to determine if any indicative questions were already answered by published work. Unanswered indicative questions entered a three-round modified Delphi process, whereby 29 experts in regional anaesthesia (representing all participating specialist societies) rated each indicative question for inclusion on a final high priority shortlist. If ≥75% of participants rated an indicative question as ‘definitely’ include in any round, it was accepted. Indicative questions rated as ‘definitely’ or ‘probably’ by <50% of participants in any round were excluded. Retained indicative questions were further ranked based on the rating score in the final Delphi round. The final research priorities were ratified by the Delphi expert group. Results: There were 1318 responses from 516 people in the initial survey, from which 71 indicative questions were formed, of which 68 entered the modified Delphi process. Eleven ‘highest priority’ research questions were short listed, covering themes of pain management; training and assessment; clinical practice and efficacy; technology and equipment. Conclusions: We prioritised unanswered research questions in regional anaesthesia. These will inform a coordinated global research strategy for regional anaesthesia and direct investigators to address high-priority areas