Ultrasound guided transversus abdominis plane block versus intrathecal morphine for analgesia post caesarean section: which is better?

The tranversus abdominis plane (TAP) block for postoperative analgesia after caesarean section may confer potential benefits comparable to that of intrathecal opioids. We compared postoperative analgesia, and the incidence of nausea, vomiting, pruritus and sedation between the TAP block and intrathecal morphine (ITM) in patients undergoing Caesarean section. This was a prospective, randomised clinical study. Fifty American Society of Anaesthesiologists physical status I or II patients, planned for elective caesarean section under spinal anaesthesia, were randomly allocated to the TAP group (patients receiving spinal anaesthesia with bilateral TAP block without ITM) or ITM group (patients receiving spinal anaesthesia with ITM without a TAP block). Assessment for pain, postoperative nausea and vomiting, pruritus and sedation was done upon arrival and discharge from recovery, and at 6, 12 and 24 hours, postoperatively in the post natal ward. Results were analysed using analysis of variance (ANOVA). There was no pain at rest in either groups. Both groups experienced pain on movement at the 12th (p = 0.6) and 24th hour (p = 0.4). None of the patients in the TAP group experienced nausea, vomiting, pruritus or sedation. However, these incidences were found to be significantly higher in the ITM group. Ultrasound guided TAP block provided comparable postoperative analgesia to ITM without the side effects of the latter

Evaluation of two different doses of pre-emptive intravenous magnesium sulphate as post operative adjunct analgesia after gynaecological surgery

This study compared the analgesic effects of pre-emptive intravenous magnesium sulphate of different dosages in patients undergoing lower abdominal gynaecological surgery. Fifty-six patients with Body Mass Index (BMI) <35 kg/m2 who underwent lower abdominal gynaecological surgery were randomly recruited into two groups. Group I received one ampoule (2.47 g) of magnesium sulphate and Group II received 50 mg/kg magnesium sulphate (based on body weight), pre-operatively. Pain score and patient controlled analgesia (PCA) morphine requirement were compared at 30 minutes, 12 hours and 24 hours post-operatively. The pain score was comparable at all intervals between the two groups (30 minutes, p = 0.450; 12 hours, p = 0.402; and 24 hours, p = 1.000). Post-operative PCA morphine requirement was not statistically significant between the two groups at 30 minutes, 12 hours, and 24 hours (2.7 vs 2.4 mg, p = 0.545; 12.5 vs 9.8 mg, p = 0.154; 7.7 vs 6.4 mg, p = 0.323). The side-effects of magnesium sulphate on blood pressure, heart rate and sedation were not statistically significant between the two groups. In conclusion, the analgesic effects of pre-emptively administered intravenous MgSO4 of 2.47 g (one ampule) was comparable to 50 mg/kg in patients with BMI less than 35 kg/m2 following lower abdominal gynaecological surgery under general anaesthesia with negligible side effects

Neovascularization in Tissue Engineering

A prerequisite for successful tissue engineering is adequate vascularization that would allow tissue engineering constructs to survive and grow. Angiogenic growth factors, alone and in combination, have been used to achieve this, and gene therapy has been used as a tool to enable sustained release of these angiogenic proteins. Cell-based therapy using endothelial cells and their precursors presents an alternative approach to tackling this challenge. These studies have occurred on a background of advancements in scaffold design and assays for assessing neovascularization. Finally, several studies have already attempted to translate research in neovascularization to clinical use in the blossoming field of therapeutic angiogenesis