Manish Kumar Singh

Abstract

Introduction: Patients suffering from advanced upper abdominal malignancies have pain as predominant symptom affects their quality of life and survival. USG guided coeliac plexus neurolysis become benevolence in these patients on part of their pain management and quality of life improvement. Objective: To compare the efficacy of USG guided coeliac plexus neurolysis for pain relief in upper abdominal malignancies by using different concentration of alcohol (50% vs 75%). Materials and Methods: This Prospective, comparative, randomised double blinded study was conducted during Sep 2019 – Aug 2020 at our tertiary care centre. Total 60 cases were taken as per following inclusion and exclusion criteria and randomly divided into 2 groups i.e. 30 each group, we compare Visual Analogue Scale (VAS) score, quality of life (QOL) and need of rescue analgesia profile between the groups to know the efficacy of USG guided coeliac plexus block. Observation and Result: In our study, we observed that the baseline mean VAS score in group I was 8.26±0.78 while in group II was 8.03±0.76. No significant difference was found in mean VAS score at this time between the groups (p=0.24). The baseline mean QOL score in group-I was 77.46±3.40 while for the cases of group II the mean QOL score was 77.36±3.33. No significant difference was found in mean QOL score at baseline between the groups (p=0.90). The baseline mean morphine consumption in group-I was 113.33±39.24 mg while for the cases of group-II the mean morphine consumption was 120.33±38.37mg. No significant difference was found in mean morphine consumption at this time between the groups (p=0.48). Both groups having 50% alcohol and 75% alcohol decreases the VAS score from baseline in patients having upper abdominal malignancies along with QOL and dosages of rescue analgesia whereas no significant difference in VAS score in patients of both groups. Keywords: Celiac plexus, Neurolysis, Alcohol, Abdominal malignancy.

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Abstract

Introduction: Postoperative nausea vomiting [PONV] is very common complication in patient undergoing surgery. Despite various medication and patient factors anaesthesiologists continues to face discomfort in preventing PONV. This study compares the incidence of nausea and vomiting during initial 24 h post anaesthesia, need for any rescue medication, satisfaction of patients and incidence of adverse effects between ondansetron & palonosetron. Methodology: In this study a total 60 patients of ASA I II, scheduled for open cholecystectomy, were selected and double blind randomization done in two groups, which either receive inj ondansetron 4mg or inj Palonosetron 75mcg before initiation of induction of anaesthesia. The events of nausea and vomiting and need of any rescue antiemetic drug was monitored at 0–2, 2–6, 6–24hrs and 0-24hrs after surgery. The visual analogue scale (VAS; 0, no nausea; 10, worst nausea) used to assess severity of PONV. Inj Metoclopramide 10 mg i.v. was adminstered as a rescue antiemetic. Adverse effects including headaches, dizziness, constipation and myalgia were recorded. Satisfaction on a three-point scale (satisfied, equivocal, dissatisfied) after 24 hr were recorded. Result: There is increased incidence of nausea & vomiting in ondansetron than palonosetron group at 0- 2, 2-6, 6-24 and at 0-24 hrs with significant difference between both groups (p value study the incidence of adverse effects like presence of new headache, any dizziness, complains of myalgia, constipation were found nearly similar in both groups. In ondansetron group nearly 13% patients needed rescue antiemetic whereas in palonosetron group 7% patients needed rescue antiemetic but the difference was not significant (p value>0.05). After 24 hr of surgery patients in palonosetron group were more satisfied than ondansetron group without any significant difference (p value>0.05). Conclusion: Effectiveness of Palonosetron in preventing PONV found to be significantly more than that of Ondansetron. Decreased incidence of adverse effects, less need of rescue antiemetic drugs & having more patient satisfaction found in palonosetron group. Keywords: 

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