Effectiveness of addition of neostigmine or dexamethasone to local anaesthetic in providing perioperative analgesia for brachial plexus block: A prospective, randomized, double blinded, controlled study

Background: Various local anaesthetic agents are used for brachial plexus block.We compared effectiveness of addition of Dexamethasone versus Neostigmine to Lignocaine, adrenaline admixtures for Brachial plexus block in providing perioperative analgesia. Methods: Ninety patients were randomized in three groups and were received 24ml of study drugs. The group A [Lignocaine with adrenaline (1.5%)], group B [Lignocaine with adrenaline (1.5%)] +500?g Neostigmine, and group C (Lignocaine with adrenaline (1.5%) +4mg Dexamethasone) for brachial plexus block through supraclavicular approach. The observed parameters were onset of analgesia, completion of sensory and motor blockade, Duration of analgesia, Surgeon's score, side effects, number of supplemental analgesics doses and Visual analogue scale (VAS) score for pain in 12 hour of post-operative period. Results: Mean onset of analgesia 4.6±1.1 , 4.4±0.8 , 3.8±1.8 mins in group A, B and C respectively and the Mean onset of motor blockade were 7.7±2.0, 7.0±1.8, 6.0±2.1mins in group A, B and C respectively. Similarly Mean Complete sensory block in 10.6±3, 10.4±2.5, and 8.9±2.2mins and Mean complete motor block in 17.3±4.3, 17.2±4.0 and 14.7±3.5 mins in group A, B and C respectively were achieved. Duration of analgesia was 176.5±53.5, 225.7±53.3 and 454.2±110.7 mins in group A, B and C respectively. Duration of analgesia in group C was statistically significant in comparison with other groups. The number of mean analgesic requirement by group C (0.9±0.4) was significantly (p- 0.005) lower. The mean VAS was significantly lower in group C in 12 hours post-operatively. Conclusion: The onsets of action, duration of analgesia were better in dexamethasone group and also need less number of rescue analgesics requirement. doi: 10.3126/kumj.v6i3.1704 Kathmandu University Medical Journal (2008), Vol. 6, No. 3, Issue 23, 302-309

Estimation of mean ND: Yag laser capsulotomy energy levels for membranous and fibrous posterior capsular opacification

Introduction: Posterior capsule opacification (PCO) is a visually-disabling complication of cataract surgery. Objective: To estimate energy levels for capsulotomy in various subtypes of PCO (membranous, fibrous and fibro-membranous). Materials and methods: A total of 215 patients with PCO were randomly selected and evaluated for Nd: Yag laser capsulotomy, after a quiet post-operative course of 3 months. The ocular area was arbitrarily divided into three zones: YAG zone (3mm), Optical zone (6 mm) and the peripheral zone (12mm). A colour code was assigned to the subtype of PCO in these zones: fibrous green and membranous blue. The type of PCO in each quadrant of YAG zone was estimated in percentage. Results: The statistic mean values of initial energy levels were 1.80 mJ for membranous PCO, 3.17 mJ for fibrous PCO and 2.73 mJ for fibro-membranous PCO. The mean summated energy levels for membranous PCO was 22.80 mJ for membranous PCO, 80.06 mJ for fibrous PCO and 80.48 mJ for fibro-membranous type. Conclusion: Colour coding is extremely helpful for quantification of the type of PCO and in deciding the initial energy level necessary to create capsulotomy. Fibro-membranous PCO required more summated energy despite a lower starting energy. Therefore, we recommend firing the initial shot in fibrous portion in case of fibrous-membranous type of PCO. DOI: http://dx.doi.org/10.3126/nepjoph.v4i1.5861 NEPJOPH 2012; 4(1): 108-113

Photoperiodic studies on growth and development of Impatiens balsamina L. : I. Lateral bud development and its relationship with senescence

Seedlings of Impatiens balsamina raised under ND and LD conditions were divided into two sub-groups each when they had reached 5-leaf stage. While one sub-group was left under the same condition (NDND or LDLD), the other was transferred to the other photoperiod (NDLD or LDND). NDND plants were subdivided into 2 lots. One of these was transferred to SD in May. The dates of emergence of individual branches and floral buds were recorded and the vegetative period was calculated in each case.It was found that in NDND plants floral buds were produced from all the nodes except the lowermost which produced a single vegetative branch. In LDND plants the vegetative branches were produced from the lower 9 nodes but floral buds from those above these. Small leafy structures which ultimately dried up were produced from a few top nodes in both these cases. In contrast to this in LDLD plants only vegetative branches were produced from all the nodes. In NDLD plants floral buds were produced from the lower 3-5 nodes prior to transfer to LD condition, but vegetative branches were produced from the upper nodes after this transfer. Even some of the lower floral buds reverted to vegetative state under this condition.The production of floral buds or the vegetative branches as the case may be, occurred in acropetal succession under all the photoperiodic conditions and never in basipetal manner.LDLD and NDLD plants, which did not flower at all, continued to produce lateral branches without showing any sign of senescence, while LDND and NDND ones showed yellowing of the apical growing point which spread downwards and lead ultimately to the death of the plant. The senescence was hastened when these plants were transferred to SD condition towards the end of May. The senescence therefore, appears to be related with reproductive development. The results are discussed in the light of current literature.