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A STUDY OF INTRAVENOUS DEXAMETHASONE AS AN ADJUVANT FOR POSTOPERATIVE PAIN CONTROL FOLLOWING HERNIOTOMY
ABSTRACT
Pain management following paediatric surgeries has evolved over the years;
nevertheless, there is still room for improvement. Herniotomy is a short procedure
which can be done as day-case surgery, however in our centre, patients are admitted
overnight after herniotomy partly for effective pain management. Pain after day-case
surgery impairs the resumption of activities of daily living. Effective postoperative
analgesia is therefore essential for herniotomy to be practiced as day-case surgery.
Dexamethasone possesses potent anti-inflammatory and anti-emetic properties; it can
reduce postoperative pain and improve patient well-being, with resultant early
ambulation, early feeding, and reduced need for overnight hospital stay. It may
therefore be a useful analgesic adjuvant. It was hypothesized therefore, that the use
of intravenous dexamethasone and intravenous tramadol will provide better
postoperative pain control following herniotomy, compared to intravenous tramadol
alone.
This is a prospective, randomized, double-blind and placebo-controlled study. It was
carried out at the University of Benin Teaching Hospital, Benin City. Following
Institutional Research and Ethics Committee approval, a total of 74 patients were
recruited, drawn from paediatric patients scheduled for unilateral herniotomy. All
patients received standardized general anaesthesia. Patients were randomized into
two groups. Group 1 received IV tramadol 1mg/kg and 5ml of IV normal saline while
Group 2 received IV tramadol 1mg/kg and IV dexamethasone 0.5mg/kg diluted to 5ml,
5-10 minutes before skin incision. Postoperative pain assessment was done using the
Modified Objective Pain Scale (MOPS). Data analysis was done using SPSS (Statistical Package for the Social Sciences) version 18. Level of significance was set
at p < 0.05.
There was no statistically significant difference in the socio-demographic
characteristics between the two groups. The baseline and intraoperative vital signs of
heart rate, blood pressure, SpO2 were also comparable in both groups.
The time from study drug administration to first analgesic requirement was significantly
longer in the dexamethasone/tramadol group (472.79 ± 218.42min) compared to the
tramadol/saline group (347.35 ± 273.64min) (p = 0.033). Furthermore, postoperative
paracetamol consumption was significantly higher in the tramadol/saline group
(535.15 ± 313.10) than in the dexamethasone/tramadol group (336.00 ± 288.05) (p =
0.004).
The proportion of patients with low MOPS scores was higher in the
dexamethasone/tramadol group than in the tramadol/saline group at most study time
points. However this was not statistically significant at any study time point.
The perioperative adverse events in group 1 and group 2 were bradycardia (18.92%
vs. 16.22%), laryngospasm (8.11% vs. 10.81%) and fever (24.32% vs. 10.81%).
Parental/guardian satisfaction with pain relief was similar in both groups. Most of the
parents/guardians in group 1 (62.16%) and group 2 (64.86%) reported satisfaction
with pain management to be good (p = 0.809).
This study shows that intravenous dexamethasone as an adjuvant is useful in the
management of post-herniotomy pain. The addition of intravenous dexamethasone to
tramadol prolonged time to first analgesic requirement and decreased total analgesic
consumption in the first 24 hours following herniotomy, with minimal side effects and
good parental/guardian satisfaction.
Intravenous dexamethasone therefore has a role to play in the management of post
herniotomy pain and could be used as an analgesic adjuvant for pain management
following herniotomy.
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