A Comparative Study between Desarda and Mesh Hernioplasty (Lichtenstein) in Inguinal Hernia: A multi-centre Experience
Md. Shahidul Islam, Dr. Mitheel-Ibna Islam, Md. Tarikul Islam, Dr. Anirudha Sardar
DOI : 10.5281/zenodo.7676194
Introduction: Inguinal hernia is a common problem and its repair is one of the most commonly performed procedures in general surgical practice. Several methods have been developed including Lichtenstein’s repair. Among these Lichtenstein’s repair has been the standard technique for the last few decades. In recent times a new procedure “no mesh Desarda hernia repair” has emerged as a recognized operative method for inguinal hernia repair. Aim of the study: The aim of the study was to find out the efficacy and safety profile between Desarda and Mesh Hernioplasty (Lichtenstein) in Inguinal Hermia. Methods: A comparative study between the 50 patients undergoing open mesh and Desarda repair was done based on randomization. All patients were diagnosed with an inguinal hernia from January 2019 to December 2020 at Khulna Medical College and Hospital, Khulna, Bangladesh and some private hospital, Khulna, Bangladesh. Result: During follow up, 5 (20.00%) patients suffered from chronic pain in lictenstein group compared to 3(12.00%) patients in desarda, Recurrence was 4(20.00%) seen in lictenstein group compared to 1 (4.00%) patients in desarda. Seroma was seen in 1 patients in desarda and nil in L group whereas hematoma was seen more in L group. Conclusion: The results of the study showed that the effectiveness of the Desarda technique with respect to influencing the early clinical outcomes of hernia repair is similar to that of the Lichtenstein method. However, the operator in this study showed that the Desarda repair requires significantly shorter operative time, is painless, and less Hospital stays with cost-effectiveness.
Comparative Oral Duloxetine, Melatonin And Tapentadol For Post Spinal Analgesia And Sedation In Knee Arthroscopic Surgeries
Kaneez Fatema; A.K.M Fakhrul Alam; Md. Nazmul Ahsan; Md. Mahbub Ur Rahman; Md. Shafiqul Islam
DOI : 10.5281/zenodo.7747772
Background: Arthroscopic knee surgeries are very common procedures as ambulatory day case surgeries and are preferred by most patients. Many patients complain of moderate to severe pain 24 h after surgery and pain affects the patient’s activity level and satisfaction. Post-operative pain is a frequent observation in patients undergoing knee arthroscopic surgeries and remains a challenge to anaesthesiologist. Objective: To assess the efficacy of preoperative duloxetine, melatonin and tapentadol for post spinal analgesia and sedation in knee arthroscopic surgeries. Methods: This prospective, randomized study was conducted at Anesthesia Department, Rahat Anwar Hospital, Band Road, Chandmari, Barishal, Bangladesh from June-2021 to December 2022. After Institutional Ethical Committee clearance and written informed consent in 106 American Society of Anesthesiologists (ASA) I and II patients of either sex between 18-60 years of age, posted for knee arthroscopic surgery under spinal anesthesia. Patients undergoing knee arthroscopic surgery requiring spinal anaesthesia were allocated randomly to four groups of oral Placebo Group A, 20 mg Duloxetine Group B, 3 mg Melatonin Group C, 100 mg Tapentadol Group D, 90 minutes before surgery. We assessed block characteristics, intraoperative sedation using Ramsay sedation scores, postoperative pain scores using Numeric Rating Score, time to use of first analgesic, 24-hours analgesic consumption, additional analgesic consumption and any adverse effects. Results: Total 106 patients Spinal anaesthesia was successfully performed. No significant difference in age, sex, weight and duration of surgery were found among the groups. Time to first post-operative analgesic request (477.96±97.85 min) and total diclofenac consumption (111.25±50.78mg) was significantly longer in Group D compared to Group A. Although post-operative pain assessed by NRS (numerical rating scale) was significantly lower in Group D as compared to Group A, B and C at 2 hours after surgery, no significant difference was observed at any time point among groups. Mean duration of post-operative analgesia was 477.96±97.85 minutes in Tapentodol Group (p value<0.001). Total 24 hours diclofenac consumption is minimum in Tapentodol Group (p 0.04). No statistical significant differences were present in the onset of the spinal block and Ramsay Sedation Score among the Groups. Conclusion: Preoperative administration of oral tapentadol provides prolonged analgesia with reduced 24-hours analgesic consumption.