Comparison of intramuscular diclofenac sodium, diclofenac sodium suppository and intravenous tramadol for postoperative analgesia in gynaecological surgeries done under spinal anaesthesia

Background: Postoperative pain management is a vital factor contributing towards speedy recovery of the patient in the perioperative period without significant morbidity. The purpose of this study was to compare the analgesic efficacy and safety of three most frequently used analgesic drugs-intramuscular diclofenac sodium, diclofenac suppository and intravenous tramadol hydrochloride in patients undergoing gynaecological surgeries.Methods: A hospital based, prospective, randomized, comparative study was undertaken in tertiary care hospital for a period of two years. The study included 90 adult patients undergoing gynaecological surgeries in spinal anaesthesia. Postoperative pain intensity was assessed by visual analogue scale. Level of sedation was assessed by four point scale along with haemodynamics.Results: There were no significant changes in the pulse rate, systolic blood pressure and diastolic blood pressure after giving I.M. diclofenac, diclofenac suppository and I.V. tramadol. The mean VAS scores were comparable in all three groups (p>0.05). The level of sedation was more in tramadol group than in diclofenac intramuscular and rectal group which was statistically significant (p=0.001).Conclusions: Diclofenac suppository provides effective postoperative analgesia when compared with Inj. Diclofenac I.M. and Inj. tramadol I.V. in patients undergoing infraumbilical gynaecological surgeries with stable vitals and no side effects

Comparative evaluation of propofol-ketamine and propofol-fentanyl for minor surgical procedures

Background: Aim of the present study was to compare the clinical efficacy of combination of propofol-ketamine and propofol-fentanyl in terms of haemodynamic variables, recovery profile and side effects.Methods: The study enrolling 120 patients of (age 20-50 years) ASA grade I & II were randomly allocated in two groups of sixty each. They were undergoing short surgical procedures lasting up to 20 minutes. Group I received injection ketamine 0.5 mg/kg over 2 minutes followed by injection propofol at rate of 1 ml over 3 seconds till the end point of induction (till loss of consciousness and loss of eye lash reflex). Group II received injection fentanyl 1.5 µg/kg followed by 1 ml propofol till the end point of induction and maintenance of anesthesia. Hemodynamic variables were recorded pre, intra and postoperatively at regular intervals. Recovery and side effects was also assessed. The results were tabulated and analyzed statistically.Results: Patients in both the groups produce minor haemodynamic changes and did not differ significantly. The recovery time was longer in group I as compare to group II. We found no complications of serious type except vomiting and nausea in group II. Discharge criteria were significantly earlier in group I than group II.Conclusions: Both propofol-ketamine and propofol-fentanyl was useful for short surgical procedures but propofol-ketamine group offers more advantage.

SILYMARIN PROTECTS AGAINST COPPER-ASCORBATE INDUCED INJURY TO GOAT CARDIAC MITOCHONDRIA IN VITRO: INVOLVEMENT OF ANTIOXIDANT MECHANISM(S)

Silymarin, 'one of the component of the Milk thistle seeds Silybum marianum (L.) is used in traditional food and medicine in India. In the present study, we investigated the antioxidant activities of Silymarin against copper-ascorbate induced toxic injury to mitochondria obtained from goat heart, in vitro. Incubation of isolated cardiac mitochondria with copper-ascorbate resulted in elevated levels of lipid peroxidation and protein carbonylation of the mitochondrial membrane, a reduced level of mitochondrial GSH and altered status of antioxidant enzymes as well as decreased activities of pyruvate dehydrogenase and the Kreb's cycle enzymes, altered mitochondrial morphology, mitochondrial swelling and di-tyrosine level. All these changes were found to be ameliorated when the cardiac mitochondria were co-incubated with copper-ascorbate and Silymarin, in vitro. Silymarin, in our in vitro experiments, was found to scavenge hydrogen peroxide, superoxide anion free radicals, hydroxyl radicals and DPPH radical, in a chemically defined system, indicating that this compound may provide protection to cardiac mitochondria against copper-ascorbate induced toxic injury through its antioxidant activities. The results of this study suggest that Silymarin may be considered as a future therapeutic antioxidant and may be used singly or as a co-therapeutic in the treatment of diseases associated with mitochondrial oxidative stress